Healthcare Provider Details

I. General information

NPI: 1033226717
Provider Name (Legal Business Name): DEBORAH SUSAN TALMAGE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 W BROADWAY AVE #300
ROBBINSDALE MN
55422-5604
US

IV. Provider business mailing address

10679 SHADY OAK CT N
CHAMPLIN MN
55316-3041
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: