Provider Demographics
NPI:1427768100
Name:HANSON, HANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9342
Mailing Address - Country:US
Mailing Address - Phone:208-367-8989
Mailing Address - Fax:
Practice Address - Street 1:717 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9342
Practice Address - Country:US
Practice Address - Phone:208-367-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-84732251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT61326728OtherWASHINGTON PHYSICAL THERAPY LICENSE
IDPT-8473OtherIDAHO PHYSICAL THERAPY LICENSE