Healthcare Provider Details

I. General information

NPI: 1144932716
Provider Name (Legal Business Name): JENNA BUELTEL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BROWN

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 PHALEN BLVD
SAINT PAUL MN
55130-2400
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12173
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: