Healthcare Provider Details

I. General information

NPI: 1467790980
Provider Name (Legal Business Name): LAUREN A HANSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 WINFIELD DUNN PKWY STE 106
KODAK TN
37764-4318
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-1088
  • Fax:
Mailing address:
  • Phone: 423-238-7568
  • Fax: 561-496-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13220
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: