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NPI Code Detail

MEDICARE: MARIE PELNER PT, DPT

MEDICARE: MARIE PELNER PT, DPT
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 TherapistPTH10726AL

General Provider Information

NPI Number : 1447904024
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE PELNER PT, DPT
Provider Business Mailing Address
First Line : 16882 JALISCO TER E
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-5571
Country : US
Telephone Number : 952-412-9824
Fax Number :
Provider Business Practice Location Address
First Line : 1779 WOODSIDE RD STE 102
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94061-3461
Country : US
Telephone Number : 650-780-9700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2022
Last Update Date : 02/11/2022

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