Individual
JACQUELYN HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2000 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-3713
(651) 251-2424
Mailing address
2000 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-3713
(651) 251-2424
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A562
MN
Other
Enumeration date
03/27/2015
Last updated
03/27/2015
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