Mary Alice Hanneken, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2857-024 Issued in WI

Practice address

1516 W. Mequon Rd
Ste 201
Mequon, WI 53012-3264

Phone

(262) 241-8402

Fax

(262) 241-8403

NPI assigned

Aug 26, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1487902367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 W. MEQUON RD",
            "address_2": "STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530123264",
            "telephone_number": "262-241-8402",
            "fax_number": "262-241-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 W. MEQUON RD",
            "address_2": "STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530123264",
            "telephone_number": "262-241-8402",
            "fax_number": "262-241-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNEKEN",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-26",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "2857-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Mequon, WI
• Providers in Mequon, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.