MEDICARE: TYLER M HANSON PT, DPT, OCS

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	360816-2401	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	CJ9402	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69157	OTHER	UT	PEHP
2	870388269BR1	OTHER	UT	EDUCATORS MUTUAL
3	QM0000061055	OTHER	UT	ALTIUS
4	5417	OTHER	UT	DMBA
5	6400593	OTHER	UT	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1922009695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER M HANSON PT, DPT, OCS

Provider Business Mailing Address
First Line	:	370 E SOUTH TEMPLE
Second Line	:	SUITE 250
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1206
Country	:	US
Telephone Number	:	801-512-2656
Fax Number	:	801-906-0336

Provider Business Practice Location Address
First Line	:	370 E SOUTH TEMPLE
Second Line	:	SUITE 250
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1206
Country	:	US
Telephone Number	:	801-512-2656
Fax Number	:	801-906-0336

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/12/2012

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