Healthcare Provider Details

I. General information

NPI: 1275785347
Provider Name (Legal Business Name): MARK OHLMANN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 WHISPERING OAKS TRL
SHAKOPEE MN
55379-8513
US

IV. Provider business mailing address

8820 WHISPERING OAKS TRL
SHAKOPEE MN
55379-8513
US

V. Phone/Fax

Practice location:
  • Phone: 651-276-3416
  • Fax:
Mailing address:
  • Phone: 651-276-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: