Provider Demographics
NPI:1144994518
Name:HANSON, EMMA RAY (ATC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:RAY
Last Name:HANSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLADYS
Mailing Address - State:VA
Mailing Address - Zip Code:24554-2884
Mailing Address - Country:US
Mailing Address - Phone:434-610-3965
Mailing Address - Fax:
Practice Address - Street 1:20311B TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7203
Practice Address - Country:US
Practice Address - Phone:434-237-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer