Healthcare Provider Details

I. General information

NPI: 1790355998
Provider Name (Legal Business Name): TERESA MARIE HANSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GRAND AVE E
GRAND MEADOW MN
55936-2600
US

IV. Provider business mailing address

1286 WILLOW LN SW
ROCHESTER MN
55902-1809
US

V. Phone/Fax

Practice location:
  • Phone: 507-358-8214
  • Fax:
Mailing address:
  • Phone: 507-358-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA1932
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: