Healthcare Provider Details

I. General information

NPI: 1316877988
Provider Name (Legal Business Name): RACHEL HANSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3797 N SHORE DR
EAU CLAIRE WI
54703-2264
US

IV. Provider business mailing address

3797 N SHORE DR
EAU CLAIRE WI
54703-2264
US

V. Phone/Fax

Practice location:
  • Phone: 530-514-9761
  • Fax:
Mailing address:
  • Phone: 530-514-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3041-19
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: