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General NPI Number Information
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NPI Number | 1891796124
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Entity Type | Individual
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Provider Name | JONI VANSELOW PT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4010 W 65TH ST SUITE 105
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City | EDINA
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State | MN
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Zip | 55435-1721
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Country | US
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Telephone | 952-285-2840
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Fax | 952-285-2830
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Provider Business Mailing Address
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Address Line | 6933 BLACK DUCK DR
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City | LINO LAKES
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State | MN
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Zip | 55014-1319
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Country | US
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Telephone | 651-426-8830
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 2169
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License Number State | MN
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