Healthcare Provider Details

I. General information

NPI: 1326863234
Provider Name (Legal Business Name): MADELINE RAE GETCHELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 GOLDEN VALLEY RD STE 202
GOLDEN VALLEY MN
55427-4475
US

IV. Provider business mailing address

13113 VINTAGE ST NW
COON RAPIDS MN
55448-1184
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13718
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: