Provider Demographics
NPI:1730232752
Name:HANSON EASTSIDE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:HANSON EASTSIDE PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT ATC
Authorized Official - Phone:605-371-4410
Mailing Address - Street 1:1914 S SYCAMORE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-4219
Mailing Address - Country:US
Mailing Address - Phone:605-371-4410
Mailing Address - Fax:605-371-4416
Practice Address - Street 1:1914 S SYCAMORE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-4219
Practice Address - Country:US
Practice Address - Phone:605-371-4410
Practice Address - Fax:605-371-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834710Medicaid
SD20522OtherSIOUX VALLEY HEALTH PLAN
SD2438329OtherAMERICAS PPO
SD4995112OtherWELLMARK BCBS SD
MN93658HAOtherWELLMARK BCBS MN
SDF246683OtherMIDLANDS CHOICE
SD103978OtherHEALTH PARTNERS
SD6405469OtherUNITED HEALTH CARE MEDICA
SD1039OtherDAKOTA CARE
SD5834710Medicaid