Healthcare Provider Details

I. General information

NPI: 1619607348
Provider Name (Legal Business Name): ELEANOR MONSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10961 CLUB WEST PKWY
BLAINE MN
55449-5866
US

IV. Provider business mailing address

9838 XERXES CURV S
BLOOMINGTON MN
55431-2865
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone: 952-388-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number12676
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: