Healthcare Provider Details

I. General information

NPI: 1982731345
Provider Name (Legal Business Name): THOMAS DANIEL HANSEN LMP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SW BLAINE ST SUITE B
PULLMAN WA
99163-2813
US

IV. Provider business mailing address

115 SW BLAINE ST SUITE B
PULLMAN WA
99163-2813
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-3380
  • Fax: 509-334-3657
Mailing address:
  • Phone: 509-332-3380
  • Fax: 509-334-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: