Provider Demographics
NPI:1548465636
Name:HANSON, STEPHEN LEE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:HANSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-3000
Mailing Address - Country:US
Mailing Address - Phone:940-393-5575
Mailing Address - Fax:866-210-0568
Practice Address - Street 1:1116 HALSELL ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-3000
Practice Address - Country:US
Practice Address - Phone:940-393-5575
Practice Address - Fax:866-210-0568
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN