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General NPI Number Information
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NPI Number | 1922626803
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Entity Type | Individual
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Provider Name | COLIN HANSEN
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Gender | Male
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3400 HIGHWAY 528 NW STE 106A
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-7025
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Country | US
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Telephone | 505-800-7810
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Fax | 505-800-7810
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Provider Business Mailing Address
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Address Line | 15 APEX DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1282
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Country | US
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Telephone | 877-224-4354
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Fax | 618-654-5439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5710
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License Number State | NM
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