Healthcare Provider Details

I. General information

NPI: 1982049110
Provider Name (Legal Business Name): PETER JOHN HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER JOHN HANSEN PHYSICAL THERAPY ASS

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 DETROIT ST 313
DENVER CO
80206-2491
US

IV. Provider business mailing address

1380 DETROIT ST 313
DENVER CO
80206-2491
US

V. Phone/Fax

Practice location:
  • Phone: 831-297-0791
  • Fax: 303-388-0845
Mailing address:
  • Phone: 831-297-0791
  • Fax: 303-388-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPTA.0012840
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: