Individual
JARED WADE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2319 7TH ST W, SAINT PAUL, MN 55116-2813
(651) 251-3078
(651) 698-3910
Mailing address
5816 AQUILA AVE N, NEW HOPE, MN 55428-3136
(641) 512-4275
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A1456
MN
Other
Enumeration date
11/27/2012
Last updated
11/29/2012
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