=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073904306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MUGGE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2015
-----------------------------------------------------
Last Update Date | 02/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4155 COUNTY ROAD 101 N 2ND FLOOR
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55446-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-993-8999
-----------------------------------------------------
Fax | 952-993-8242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17905 96TH AVE N
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55311-1270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-993-8999
-----------------------------------------------------
Fax | 952-993-8242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 9852
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070020567
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------