Healthcare Provider Details

I. General information

NPI: 1518144740
Provider Name (Legal Business Name): SUSAN HIETALA LEVAHN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PLEASANT AVE
HASTINGS MN
55033
US

IV. Provider business mailing address

1175 NINENGER
HASTINGS MN
55033
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-6831
  • Fax: 651-480-4339
Mailing address:
  • Phone: 651-480-4100
  • Fax: 651-480-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4036
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: