Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 9082 | MA |
NPI | 1043415441 |
---|---|
Provider Name | Mr. Craig Alexander Hansen I |
First Address | Wilmington, MA 01887-1905 |
Second Address | Stoneham, MA 02180-3629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/01/2016 |