Healthcare Provider Details

I. General information

NPI: 1881971794
Provider Name (Legal Business Name): RESADA KATHRYN ENBERG PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2011
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

410 N 5TH ST
MONTEVIDEO MN
56265-1508
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6079
  • Fax: 320-762-6123
Mailing address:
  • Phone: 320-226-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2187
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number10378
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: