Provider Demographics
NPI:1679312250
Name:HANSON, NICHOLAS SCOTT
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S DAYLIGHT DR APT 337
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6989
Mailing Address - Country:US
Mailing Address - Phone:605-759-4623
Mailing Address - Fax:
Practice Address - Street 1:1210 W 18TH ST STE LL01
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4655
Practice Address - Country:US
Practice Address - Phone:605-328-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist