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General NPI Number Information
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NPI Number | 1154448421
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Entity Type | Individual
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Provider Name | CHERRON MARIE KINGZETT HALVORSON DPT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 42 6TH AVE SE
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City | MAYVILLE
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State | ND
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Zip | 58257-1506
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Country | US
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Telephone | 701-788-4439
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Fax |
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Provider Business Mailing Address
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Address Line | 550 32ND ST NE
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City | NORTHWOOD
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State | ND
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Zip | 58267-9525
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Country | US
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Telephone | 218-791-6291
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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 | 7574
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License Number State | MN
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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 | 1557
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License Number State | ND
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