Provider Demographics
NPI:1487206058
Name:HANNUKSELA, MARIA LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:HANNUKSELA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705-1256
Mailing Address - Country:US
Mailing Address - Phone:218-780-3994
Mailing Address - Fax:
Practice Address - Street 1:208 MAIN ST N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705-1346
Practice Address - Country:US
Practice Address - Phone:218-780-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41041267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist