Provider Demographics
NPI:1053927400
Name:DYKSTRA, ANNALISA ELAINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNALISA
Middle Name:ELAINE
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S CREYTS RD
Mailing Address - Street 2:STE B
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8290
Mailing Address - Country:US
Mailing Address - Phone:517-327-0966
Mailing Address - Fax:517-327-0986
Practice Address - Street 1:416 S CREYTS RD STE B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8290
Practice Address - Country:US
Practice Address - Phone:517-327-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist