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General NPI Number Information
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NPI Number | 1588630479
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Entity Type | Individual
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Provider Name | MARIAH JOY OHLSEN DPT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1687 WOODLANE DR SUITE 104
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City | WOODBURY
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State | MN
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Zip | 55125-3045
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Country | US
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Telephone | 651-702-0555
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Fax | 651-702-5680
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Provider Business Mailing Address
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Address Line | 4609 PORTLAND AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3551
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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 | 7242
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License Number State | MN
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