Provider Demographics
NPI:1194903468
Name:HANSON, HEATHER A (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:501 JOHN MAHAR HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6563
Mailing Address - Country:US
Mailing Address - Phone:781-214-1717
Mailing Address - Fax:339-201-3374
Practice Address - Street 1:501 JOHN MAHAR HWY STE 100
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6563
Practice Address - Country:US
Practice Address - Phone:781-214-1717
Practice Address - Fax:339-201-3374
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA11745225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist