Provider Demographics
NPI:1982799219
Name:HANSON, JONATHAN HAROLD (PT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HAROLD
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 1:1813 O AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2344
Mailing Address - Country:US
Mailing Address - Phone:360-588-8075
Mailing Address - Fax:360-588-0406
Practice Address - Street 1:1813 O AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2344
Practice Address - Country:US
Practice Address - Phone:360-588-8075
Practice Address - Fax:360-588-0406
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0196048OtherDEPT. OF L & I
WA7458743OtherAETNA
WA5637607OtherFIRST HEALTH
WA8343170Medicaid
WA7458743OtherAETNA