Healthcare Provider Details

I. General information

NPI: 1659032472
Provider Name (Legal Business Name): COURTNEY ANN THIELEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date: 06/24/2025
Reactivation Date: 08/06/2025

III. Provider practice location address

2835 W SAINT GERMAIN ST STE 300
SAINT CLOUD MN
56301-6281
US

IV. Provider business mailing address

2835 W SAINT GERMAIN ST STE 300
SAINT CLOUD MN
56301-6281
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4151
  • Fax:
Mailing address:
  • Phone: 320-259-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13890
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: