Provider Demographics
NPI:1982049110
Name:HANSEN, PETER JOHN
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:JOHN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPY ASS
Mailing Address - Street 1:1380 DETROIT ST
Mailing Address - Street 2:313
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2491
Mailing Address - Country:US
Mailing Address - Phone:831-297-0791
Mailing Address - Fax:303-388-0845
Practice Address - Street 1:1380 DETROIT ST
Practice Address - Street 2:313
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2491
Practice Address - Country:US
Practice Address - Phone:831-297-0791
Practice Address - Fax:303-388-0845
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012840171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor