Provider Demographics
NPI:1366875759
Name:HANSON, JAMES (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:COALDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18218-1007
Mailing Address - Country:US
Mailing Address - Phone:570-449-3753
Mailing Address - Fax:
Practice Address - Street 1:18 E FOSTER AVE
Practice Address - Street 2:
Practice Address - City:COALDALE
Practice Address - State:PA
Practice Address - Zip Code:18218-1007
Practice Address - Country:US
Practice Address - Phone:570-449-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist