=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477492676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY AMBER NORDAHL DPT
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6500 FRANCE AVE S
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-568-7922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 3RD ST W
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-497-4458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number | 11333
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------