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General NPI Number Information
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NPI Number | 1841717188
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Entity Type | Individual
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Provider Name | MICHELLE ECKLUND
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 1661 SAINT ANTHONY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-3733
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Country | US
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Telephone | 651-968-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 5707 HIGHWAY 7 APT 307
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-5084
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Country | US
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Telephone | 715-741-1214
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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 | 10708
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License Number State | MN
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