Healthcare Provider Details

I. General information

NPI: 1073626008
Provider Name (Legal Business Name): PDR SOUTHDALE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 66TH ST SUITE 450
EDINA MN
55435-2111
US

IV. Provider business mailing address

11822 BREN RD
MINNETONKA MN
55343-9464
US

V. Phone/Fax

Practice location:
  • Phone: 952-908-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name: DR. TODD WALLACE GINKEL
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 952-908-2700