Provider Demographics
NPI:1548539414
Name:HANSON, RACHEL BETH (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BETH
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:BETH
Other - Last Name:STOCKDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-6082
Mailing Address - Fax:573-449-0401
Practice Address - Street 1:100 E DAVIS ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1405
Practice Address - Country:US
Practice Address - Phone:660-248-3053
Practice Address - Fax:660-248-2682
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL35000028Medicare PIN
MO152100017Medicare PIN