=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497143507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION PERFORMANCE AND THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2014
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1760 W CHERRY LN STE 130
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-760-9988
-----------------------------------------------------
Fax | 208-376-7487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3754 W BEDROCK DR
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83646-9027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-760-9988
-----------------------------------------------------
Fax | 208-376-7487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTOPHER J HANSEN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 208-760-9988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT-2832
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------