MEDICARE: RACHEL M HAKANSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8548	OTHER	MN	LICENSE

General Provider Information

NPI Number	:	1306157680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL M HAKANSON DPT

Provider Business Mailing Address
First Line	:	18912 LAKE DR E
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9348
Country	:	US
Telephone Number	:	952-908-2730
Fax Number	:	952-908-3731

Provider Business Practice Location Address
First Line	:	18912 LAKE DR E
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9348
Country	:	US
Telephone Number	:	952-908-2730
Fax Number	:	952-908-3731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	12/01/2010

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