Healthcare Provider Details

I. General information

NPI: 1588630479
Provider Name (Legal Business Name): MARIAH JOY OHLSEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 WOODLANE DR SUITE 104
WOODBURY MN
55125-3045
US

IV. Provider business mailing address

4609 PORTLAND AVE
MINNEAPOLIS MN
55407-3551
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0555
  • Fax: 651-702-5680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7242
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: