Healthcare Provider Details

I. General information

NPI: 1932348653
Provider Name (Legal Business Name): ELIZABETH C HANSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 SUGAR HILL RD
CHIMACUM WA
98325-7732
US

IV. Provider business mailing address

PO BOX 327
CHIMACUM WA
98325-0327
US

V. Phone/Fax

Practice location:
  • Phone: 360-774-0676
  • Fax:
Mailing address:
  • Phone: 360-774-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1073
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5904
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2489
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60102251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: