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General NPI Number Information
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NPI Number | 1538047253
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Entity Type | Individual
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Provider Name | AMBER LYNN WURDOCK
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Gender | Female
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 1107 HART BLVD STE 10
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City | MONTICELLO
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State | MN
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Zip | 55362-8539
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Country | US
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Telephone | 763-295-6878
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Fax |
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Provider Business Mailing Address
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Address Line | 13650 MARSH VIEW BLVD APT 112
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City | ROGERS
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State | MN
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Zip | 55374-6034
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Country | US
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Telephone |
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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 | 14007
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License Number State | MN
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