Healthcare Provider Details

I. General information

NPI: 1295217123
Provider Name (Legal Business Name): EDWARD FRANCIS ARNDORFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 1ST ST S
WILLMAR MN
56201-4243
US

IV. Provider business mailing address

1604 1ST ST S
WILLMAR MN
56201-4243
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-6918
  • Fax: 320-214-6147
Mailing address:
  • Phone: 320-214-6918
  • Fax: 320-214-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA146
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: