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NPI Code Detail

MEDICARE: MAGGIE LYNN MORLEY HENJUM DPT, OCS, FAAOMPT

MEDICARE: MAGGIE LYNN MORLEY HENJUM DPT, OCS, FAAOMPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistMN
2225100000XPhysical Therapist8777MN

General Provider Information

NPI Number : 1003109943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAGGIE LYNN MORLEY HENJUM DPT, OCS, FAAOMPT
Provider Business Mailing Address
First Line : 1939 MINNEHAHA AVE W STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1033
Country : US
Telephone Number : 651-348-7428
Fax Number : 651-348-7432
Provider Business Practice Location Address
First Line : 1939 MINNEHAHA AVE W STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1033
Country : US
Telephone Number : 651-348-7428
Fax Number : 651-348-7432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 06/21/2021

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