MEDICARE: CHASE N HANSEN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501015465	MI

General Provider Information

NPI Number	:	1073819264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE N HANSEN DPT

Provider Business Mailing Address
First Line	:	13070 N LEWIS RD
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-2605
Country	:	US
Telephone Number	:	989-274-0323
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9668
Country	:	US
Telephone Number	:	989-272-4500
Fax Number	:	989-272-4501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	07/21/2022

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Directions to “ CHASE N HANSEN DPT” Practice Location

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