Healthcare Provider Details

I. General information

NPI: 1346219862
Provider Name (Legal Business Name): MICHELLE MARIE HOSFIELD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE GUSE PT

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 LEXINGTON AVE N
SHOREVIEW MN
55126-6106
US

IV. Provider business mailing address

330 LINDA LN
LINO LAKES MN
55014-6402
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-1455
  • Fax:
Mailing address:
  • Phone: 612-262-4813
  • Fax: 612-262-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5075
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: