Individual
CHARLES SPENCER HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
650 ADDISON AVE W, TWIN FALLS, ID 83301-5444
(208) 737-2000
Mailing address
PO BOX 409, TWIN FALLS, ID 83303-0409
(208) 737-2000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2742
ID
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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