Provider Demographics
NPI:1528133717
Name:HANSEN, DENISE MARIE (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN445861300Medicaid
MN6401893OtherMEDICA
MNHP32970OtherHEALTHPARTNERS
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN73B31HAOtherBLUE CROSS BLUE SHIELD
MN6401893OtherSELECT CARE
MN1093560003Medicare NSC
MN6401893OtherMEDICA
MN650000627Medicare PIN
MNHP32970OtherHEALTHPARTNERS