Provider Demographics
NPI:1053887067
Name:HANSEN, CHASE K (DPT)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:K
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E BRICKYARD RD APT 1803
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2531
Mailing Address - Country:US
Mailing Address - Phone:801-309-0848
Mailing Address - Fax:
Practice Address - Street 1:1121 E BRICKYARD RD APT 1803
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2531
Practice Address - Country:US
Practice Address - Phone:801-309-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10787299-24012081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine