Provider Demographics
NPI:1932348653
Name:HANSEN, ELIZABETH C (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325-0327
Mailing Address - Country:US
Mailing Address - Phone:360-774-0676
Mailing Address - Fax:
Practice Address - Street 1:692 SUGAR HILL RD
Practice Address - Street 2:
Practice Address - City:CHIMACUM
Practice Address - State:WA
Practice Address - Zip Code:98325-7732
Practice Address - Country:US
Practice Address - Phone:360-774-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1073225100000X
OR5904225100000X
ID2489225100000X
WA60102251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist