Healthcare Provider Details

I. General information

NPI: 1790696821
Provider Name (Legal Business Name): NATALIE HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21395 JOHN MILLESS DR STE 600
ROGERS MN
55374-4406
US

IV. Provider business mailing address

18294 GLADSTONE BLVD N
MAPLE GROVE MN
55311-1100
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-2589
  • Fax:
Mailing address:
  • Phone: 763-688-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14529
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: