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General NPI Number Information
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NPI Number | 1154394443
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Entity Type | Individual
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Provider Name | KRISTINE JOYCE GJERDE PT
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1711 COUNTY ROAD B W SUITE 102 SOUTH
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City | ROSEVILLE
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State | MN
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Zip | 55113-4057
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Country | US
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Telephone | 651-635-0046
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Fax | 651-635-0112
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Provider Business Mailing Address
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Address Line | 71 MCKNIGHT RD N
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City | SAINT PAUL
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State | MN
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Zip | 55119-4616
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Country | US
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Telephone | 651-714-9282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2544-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1110
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License Number State | MN
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