MEDICARE: MRS. JOAN E HANSON PT

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	0531	SD

General Provider Information

NPI Number	:	1487723623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN E HANSON PT

Provider Business Mailing Address
First Line	:	27306 MEADOW RIDGE RD
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-8233
Country	:	US
Telephone Number	:	605-334-8616
Fax Number	:	605-339-6982

Provider Business Practice Location Address
First Line	:	1721 S CLEVELAND AVE
Second Line	:	SUITE 200
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5501
Country	:	US
Telephone Number	:	605-334-8616
Fax Number	:	605-339-6982

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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