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NPI Code Detail

MEDICARE: JACQUELYN HANSON PTA

MEDICARE: JACQUELYN HANSON PTA
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
1225200000XPhysical Therapy AssistantA562MN

General Provider Information

NPI Number : 1184018053
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN HANSON PTA
Provider Business Mailing Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 651-251-2424
Fax Number :
Provider Business Practice Location Address
First Line : 2000 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-3713
Country : US
Telephone Number : 651-251-2424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 03/27/2015

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Directions to “ JACQUELYN HANSON PTA” Practice Location

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