Provider Demographics
NPI:1891409777
Name:HANUSH, ERIKA LYN (LMT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LYN
Last Name:HANUSH
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 1:5876 W LUNA ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5096
Mailing Address - Country:US
Mailing Address - Phone:479-274-8317
Mailing Address - Fax:
Practice Address - Street 1:2011 N GREEN ACRES RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2611
Practice Address - Country:US
Practice Address - Phone:479-274-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist