Healthcare Provider Details

I. General information

NPI: 1033261110
Provider Name (Legal Business Name): MRS. GLADYS MARIE MURPHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NORTH MAIN STREET
PARK RAPIDS MN
56470
US

IV. Provider business mailing address

10772 CO RD 13
SEBOKA MN
56477
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-7266
  • Fax: 218-732-0136
Mailing address:
  • Phone: 218-564-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: