Provider Demographics
NPI:1487918462
Name:HANSON, PAIGE JOY (LMT, LR)
Entity type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:JOY
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMT, LR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 42ND ST S APT 208
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7107
Mailing Address - Country:US
Mailing Address - Phone:320-305-2257
Mailing Address - Fax:
Practice Address - Street 1:805 14TH ST. SO.
Practice Address - Street 2:MSUM WELLNESS CENTER
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:320-305-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMST12-28225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist