Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 6456 | CA |
NPI | 1013280510 |
---|---|
Provider Name | Melissa Sue Hanson |
First Address | Livermore, CA 94551 |
Second Address | Livermore, CA 94551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |