Healthcare Provider Details

I. General information

NPI: 1932302148
Provider Name (Legal Business Name): JAKE INGWER HANSON D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY STE 200
TACOMA WA
98402-3400
US

IV. Provider business mailing address

2974 37TH AVE NE
TACOMA WA
98422-2640
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-6400
  • Fax:
Mailing address:
  • Phone: 253-394-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT00010022
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: