Healthcare Provider Details

I. General information

NPI: 1073198198
Provider Name (Legal Business Name): ALEXANDRIA HANSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N 650 W STE A
FARMINGTON UT
84025-2603
US

IV. Provider business mailing address

5349 ADAMS AVE PKWY STE A
OGDEN UT
84405-4736
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-9627
  • Fax:
Mailing address:
  • Phone: 801-479-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number12135486-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: