MEDICARE: HOPE LANE HANSEN LMT

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	225700000X	Massage Therapist	MAS-1082	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92-1734984	OTHER	ID	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1710692496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE LANE HANSEN LMT

Provider Business Mailing Address
First Line	:	1033 S 3RD ST
Second Line	:
City	:	SAINT MARIES
State	:	ID
Zip	:	83861-1909
Country	:	US
Telephone Number	:	208-596-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 S 3RD ST
Second Line	:
City	:	SAINT MARIES
State	:	ID
Zip	:	83861-8386
Country	:	US
Telephone Number	:	208-596-0014
Fax Number	:

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

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	03/12/2024

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Directions to “ HOPE LANE HANSEN LMT” Practice Location

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