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General NPI Number Information
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NPI Number | 1750213864
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Entity Type | Individual
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Provider Name | TAAVAN LI MIELKE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 26025 3RD ST E STE 100
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City | ZIMMERMAN
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State | MN
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Zip | 55398-5303
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Country | US
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Telephone | 763-482-5270
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Fax | 763-856-8626
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Provider Business Mailing Address
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Address Line | 12786 43RD ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-8477
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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 | 14340
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License Number State | MN
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