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NPI Code Detail

MEDICARE: DR. JONATHAN MICHAEL HANSCOM PT, DPT

MEDICARE: DR. JONATHAN MICHAEL HANSCOM PT, 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
1225100000XPhysical Therapist32708AZ

General Provider Information

NPI Number : 1720695679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN MICHAEL HANSCOM PT, DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 866-370-8206
Fax Number : 517-435-3670
Provider Business Practice Location Address
First Line : 1065 E TUCSON MARKETPLACE BLVD STE 155
Second Line :
City : TUCSON
State : AZ
Zip : 85713-6563
Country : US
Telephone Number : 520-719-4210
Fax Number : 520-822-8641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2020
Last Update Date : 03/02/2025

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Directions to “ DR. JONATHAN MICHAEL HANSCOM PT, DPT” Practice Location

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