MEDICARE: TANNER HANSEN

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		UT

General Provider Information

NPI Number	:	1750134706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER HANSEN

Provider Business Mailing Address
First Line	:	PO BOX 711185
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-1185
Country	:	US
Telephone Number	:	435-274-3532
Fax Number	:	435-274-3513

Provider Business Practice Location Address
First Line	:	1050 S MEDICAL DR STE A
Second Line	:
City	:	MT PLEASANT
State	:	UT
Zip	:	84647-2200
Country	:	US
Telephone Number	:	435-274-3533
Fax Number	:

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	05/31/2024

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Directions to “ TANNER HANSEN ” Practice Location

Language	Start Address	Practice Location

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