Healthcare Provider Details

I. General information

NPI: 1770755076
Provider Name (Legal Business Name): JAKOB DAVID RIKKOLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 9TH ST N ESSENTIA HEALTH VIRGINIA
VIRGINIA MN
55792-2329
US

IV. Provider business mailing address

400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-3340
  • Fax:
Mailing address:
  • Phone: 218-786-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6982
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: