Individual
MICHELLE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1952 E 7000 S, SALT LAKE CITY, UT 84121-6877
(801) 942-3311
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7482625-2402
PTA LICENSE
UT
Enumeration date
02/27/2020
Last updated
02/27/2020
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