MEDICARE: MS. MARGARET ALICE AFFELDT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4255	MN

General Provider Information

NPI Number	:	1003876749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARET ALICE AFFELDT PT

Provider Business Mailing Address
First Line	:	10589 64TH CT SE
Second Line	:
City	:	CLEAR LAKE
State	:	MN
Zip	:	55319-4606
Country	:	US
Telephone Number	:	320-743-3827
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 1ST AVE NE
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-1602
Country	:	US
Telephone Number	:	763-682-8457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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