Individual
DR. ETHAN JARED HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
300 S 6TH ST, WILLIAMS, AZ 86046-0110
(928) 635-4441
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8581
AZ
Other
Enumeration date
08/04/2009
Last updated
03/24/2021
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