Healthcare Provider Details

I. General information

NPI: 1245429018
Provider Name (Legal Business Name): COLBY REED HANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E SUITE 1R19
SALT LAKE CITY UT
84132-0006
US

IV. Provider business mailing address

30 N 1900 E SUITE 1R19
SALT LAKE CITY UT
84132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-2589
  • Fax:
Mailing address:
  • Phone: 801-585-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number6351860-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number6351860-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: