=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346858636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA HOULE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2020
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 4TH AVE
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-528-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10244 302ND AVE NW
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55371-3683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-746-6795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------