MEDICARE: MR. PHILLIP JAMES HANSON

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	070-012607	IL

General Provider Information

NPI Number	:	1154306041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP JAMES HANSON

Provider Business Mailing Address
First Line	:	BG CRAWFORD F. SAMS HEALTH CLINIC
Second Line	:	UNIT 45011
City	:	APO
State	:	AP
Zip	:	96343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 561 BOX 1447
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310
Country	:	US
Telephone Number	:	011816117534176
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/06/2024

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