Healthcare Provider Details

I. General information

NPI: 1780784868
Provider Name (Legal Business Name): GARY HANSEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE SUITE 201
SEATTLE WA
98105-4151
US

IV. Provider business mailing address

8041 13TH AVE NW
SEATTLE WA
98117-4204
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax: 206-524-6703
Mailing address:
  • Phone: 206-782-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: