Healthcare Provider Details

I. General information

NPI: 1811661747
Provider Name (Legal Business Name): BETHANY HANSEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 METRO BLVD STE 100
EDINA MN
55439-2145
US

IV. Provider business mailing address

7250 METRO BLVD STE 100
EDINA MN
55439-2145
US

V. Phone/Fax

Practice location:
  • Phone: 612-778-6240
  • Fax: 612-435-4947
Mailing address:
  • Phone: 612-778-6240
  • Fax: 612-435-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BETHANY HANSEN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 612-778-6240