Healthcare Provider Details

I. General information

NPI: 1407310154
Provider Name (Legal Business Name): MOLLY KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

ABBOTT NORTHWESTERN HOSPITAL 800 E 28TH ST
MINNEAPOLIS MN
55407-3732
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11370
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: