Provider Demographics
NPI:1710872205
Name:HANKE, ELLIOTT (DPT, PT)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:HANKE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 45TH AVE N APT 306
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2670
Mailing Address - Country:US
Mailing Address - Phone:269-921-1377
Mailing Address - Fax:
Practice Address - Street 1:146 LAKE ST N STE 200
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2555
Practice Address - Country:US
Practice Address - Phone:651-275-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist