Provider Demographics
NPI:1912875592
Name:HANSON, ANNIKA MARIE (LMT)
Entity type:Individual
Prefix:MISS
First Name:ANNIKA
Middle Name:MARIE
Last Name:HANSON
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 1:365 COUNTY ROAD 480
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9226
Mailing Address - Country:US
Mailing Address - Phone:256-503-4655
Mailing Address - Fax:
Practice Address - Street 1:201 RUBLEIN ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4011
Practice Address - Country:US
Practice Address - Phone:256-503-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7510106394225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty