Provider Demographics
NPI:1154450864
Name:HANSEN, SARA JANE (ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:JANE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19219 ATASCA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1457
Mailing Address - Country:US
Mailing Address - Phone:281-852-5253
Mailing Address - Fax:281-852-5253
Practice Address - Street 1:19219 ATASCA OAKS DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1457
Practice Address - Country:US
Practice Address - Phone:281-852-5253
Practice Address - Fax:281-852-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer