Provider Demographics
NPI:1386758191
Name:HANSON, KIRK ALAN (PT)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:ALAN
Last Name:HANSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4910
Mailing Address - Country:US
Mailing Address - Phone:406-443-5555
Mailing Address - Fax:406-443-5544
Practice Address - Street 1:2615 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4910
Practice Address - Country:US
Practice Address - Phone:406-443-5555
Practice Address - Fax:406-443-5544
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT235PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT340314Medicaid
MT03001377OtherSTATE FUND
MT61665OtherBCBS OF MT
MTM000005029Medicare PIN