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NPI Code Detail

MEDICARE: MERCEDES FONSECA CORDOBA PHYSICAL THERAPIST

MEDICARE: MERCEDES FONSECA CORDOBA PHYSICAL THERAPIST
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
1225100000XPhysical Therapist6011MN

General Provider Information

NPI Number : 1073758686
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERCEDES FONSECA CORDOBA PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 2450 26TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1245
Country : US
Telephone Number : 612-721-2491
Fax Number : 612-728-2400
Provider Business Practice Location Address
First Line : 2450 26TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1245
Country : US
Telephone Number : 612-721-2491
Fax Number : 612-728-2400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2008
Last Update Date : 12/10/2008

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Directions to “ MERCEDES FONSECA CORDOBA PHYSICAL THERAPIST” Practice Location

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