Individual
RENEE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
205 MOONGLOW AVE, ALAMOGORDO, NM 88310-3339
(575) 434-4510
Mailing address
205 MOONGLOW AVE, ALAMOGORDO, NM 88310-3339
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9625A
AZ
225200000X
Physical Therapy Assistant
A-0897
NM
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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