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NPI Code Detail

MEDICARE: NICOLAS RYAN HANSEN

MEDICARE: NICOLAS RYAN 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
1225200000XPhysical Therapy Assistant51911CA

General Provider Information

NPI Number : 1902767908
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLAS RYAN HANSEN
Provider Business Mailing Address
First Line : 10471 GRANT LINE RD STE 140
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-5042
Country : US
Telephone Number : 916-750-4555
Fax Number :
Provider Business Practice Location Address
First Line : 10471 GRANT LINE RD STE 140
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-5042
Country : US
Telephone Number : 916-750-4555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2025
Last Update Date : 11/19/2025

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Directions to “ NICOLAS RYAN HANSEN ” Practice Location

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