Healthcare Provider Details

I. General information

NPI: 1114965423
Provider Name (Legal Business Name): JONATHAN E. ARNTSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 GOLF COURSE RD STE 104
GRAND RAPIDS MN
55744-9603
US

IV. Provider business mailing address

1542 GOLF COURSE ROAD STE 104
GRAND RAPIDS MN
55744-3938
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3300
  • Fax: 218-326-3400
Mailing address:
  • Phone: 218-326-3300
  • Fax: 218-326-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6172
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: