Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 885 | MN |
NPI | 1073618773 |
---|---|
Provider Name | Jan Hanson |
First Address | Woodbury, MN 55125-9295 |
Second Address | Woodbury, MN 55129-9291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
034M0HA | MN BCBS (01) | MN |
6403663 | MEDICA (01) | MN |