Provider Demographics
NPI:1104235142
Name:HANSON, LAURA IMMING (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:IMMING
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:IMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6110 BRETT ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2978
Mailing Address - Country:US
Mailing Address - Phone:507-271-2040
Mailing Address - Fax:
Practice Address - Street 1:452 SE UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8121
Practice Address - Country:US
Practice Address - Phone:515-987-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist