Individual
JEREMY R HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
(812) 474-2296
Mailing address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
006252
KY
225100000X
Physical Therapist
Primary
05011316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000845434
ANTHEM BLUE CROSS BLUE SHIELD
IN
Enumeration date
08/02/2013
Last updated
02/14/2014
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