Healthcare Provider Details

I. General information

NPI: 1629098926
Provider Name (Legal Business Name): DENISE MARIE HANSEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD UNIT 3A
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

3 CALIENTE RD UNIT 3A
SANTA FE NM
87508-9209
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-2500
  • Fax: 505-466-4959
Mailing address:
  • Phone: 505-466-2500
  • Fax: 505-466-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2787
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 12520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: