Provider Demographics
NPI:1154020493
Name:HANSEN, STEPHANIE ERIKA (LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERIKA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11337 HIGHWAY 7 STE 20
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5300
Mailing Address - Country:US
Mailing Address - Phone:952-334-2651
Mailing Address - Fax:
Practice Address - Street 1:11337 HIGHWAY 7 STE 20
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5300
Practice Address - Country:US
Practice Address - Phone:952-334-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
577047-09225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty