MEDICARE: PHILLIP V HANSEN

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	225800000X	Recreation Therapist	108137-4002	UT

General Provider Information

NPI Number	:	1750271722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP V HANSEN

Provider Business Mailing Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-867-4715
Fax Number	:

Provider Business Practice Location Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-867-4715
Fax Number	:

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

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	07/09/2025

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Directions to “ PHILLIP V HANSEN ” Practice Location

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