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General NPI Number Information
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NPI Number | 1518712751
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Entity Type | Individual
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Provider Name | SUSAN HOLMQUIST MSPT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 1925 NORFOLK AVE
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City | SAINT PAUL
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State | MN
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Zip | 55116-2575
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Country | US
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Telephone | 651-294-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 6392 178TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-4804
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Country | US
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Telephone | 612-360-4121
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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 | 6939
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License Number State | MN
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