Healthcare Provider Details

I. General information

NPI: 1558935239
Provider Name (Legal Business Name): TAYLOR JONES PETERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST STE 200
EDINA MN
55439-2560
US

IV. Provider business mailing address

8100 W 78TH ST STE 200
EDINA MN
55439-2560
US

V. Phone/Fax

Practice location:
  • Phone: 952-914-8065
  • Fax:
Mailing address:
  • Phone: 952-914-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3177
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: