Active NPI
Carolyn Marissa Hansen, DPT
- Physical Therapist
- Duluth, MN
National Provider Identifier
1154635399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8493
- Practice address
- 915 E 1St St
Duluth, MN 55805-2107 - Phone
- (218) 249-5555
- NPI assigned
- Jul 29, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8493 | MN | Primary |
Addresses
Primary practice location
915 E 1St St
Duluth, MN 55805-2107
Mailing address
915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555
Other names 1
- Carolyn Marissa Despot
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457395200000",
"number": "1154635399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 E 1ST ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052107",
"telephone_number": "218-249-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 E 1ST ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052107",
"telephone_number": "218-249-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "CAROLYN",
"middle_name": "MARISSA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-29",
"last_updated": "2016-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "8493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CAROLYN",
"last_name": "DESPOT",
"middle_name": "MARISSA",
"credential": "DPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.