Healthcare Provider Details

I. General information

NPI: 1962482463
Provider Name (Legal Business Name): DAVID DWIGHT ENGELHARDT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 TRANSFER RD SUITE 16
SAINT PAUL MN
55114-1427
US

IV. Provider business mailing address

2772 IRENE CIR
ROSEVILLE MN
55113-2328
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-1625
  • Fax: 651-646-3256
Mailing address:
  • Phone: 651-484-9268
  • Fax: 651-484-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2105
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: