Healthcare Provider Details

I. General information

NPI: 1891813390
Provider Name (Legal Business Name): PETER JAMES RUNDQUIST PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CHICAGO AVE SUITE 200
MINNEAPOLIS MN
55407-1318
US

IV. Provider business mailing address

7551 9TH ST N SUITE 100
OAKDALE MN
55128-6629
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-2700
  • Fax:
Mailing address:
  • Phone: 651-748-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008173A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4520
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: