MEDICARE: LAURA A HANSON 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	40QA01295200	NJ

General Provider Information

NPI Number	:	1629229422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A HANSON DPT

Provider Business Mailing Address
First Line	:	6307 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2273
Country	:	US
Telephone Number	:	609-822-2628
Fax Number	:	609-822-5173

Provider Business Practice Location Address
First Line	:	6307 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2273
Country	:	US
Telephone Number	:	609-822-2628
Fax Number	:	609-822-5173

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	08/03/2020

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