Provider Demographics
NPI:1285139782
Name:GUSTAFSSON, HANNA CHRISTINE (PT, DPT, CLT)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:CHRISTINE
Last Name:GUSTAFSSON
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 AVANTE CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2505
Mailing Address - Country:US
Mailing Address - Phone:509-670-8907
Mailing Address - Fax:
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:720-890-1091
Practice Address - Fax:729-890-1098
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist