Healthcare Provider Details

I. General information

NPI: 1740171602
Provider Name (Legal Business Name): NNEKA NWOKORO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PKWY STE 200
SAINT PAUL MN
55116-3412
US

IV. Provider business mailing address

6690 WILDFLOWER DR S
COTTAGE GROVE MN
55016-1732
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-5010
  • Fax:
Mailing address:
  • Phone: 612-300-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14026
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: