Healthcare Provider Details

I. General information

NPI: 1124431481
Provider Name (Legal Business Name): JOHN E AMUNDSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN E AMUNDSON DPT

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 30TH AVE E STE 102
ALEXANDRIA MN
56308-4770
US

IV. Provider business mailing address

410 30TH AVE E STE 102
ALEXANDRIA MN
56308-4770
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5505
  • Fax: 320-763-4447
Mailing address:
  • Phone: 320-763-5505
  • Fax: 320-763-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9594
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: