Healthcare Provider Details

I. General information

NPI: 1346477635
Provider Name (Legal Business Name): COLLEEN MARTENS ENDRIZZI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 COUNTY ROAD E W SUITE 240
SHOREVIEW MN
55126-8152
US

IV. Provider business mailing address

6311 WAYZATA BLVD
ST LOUIS PARK MN
55416-1209
US

V. Phone/Fax

Practice location:
  • Phone: 651-493-0626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN MARTENS ENDRIZZI
Title or Position: CEO
Credential:
Phone: 612-554-5005