MEDICARE: EMILY PAULINE NOLD 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	PT36513	CA
2	225100000X	Physical Therapist	8910	MN

General Provider Information

NPI Number	:	1326361247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PAULINE NOLD PT

Provider Business Mailing Address
First Line	:	6515 BARRIE RD STE 100
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2364
Country	:	US
Telephone Number	:	952-922-5019
Fax Number	:	952-922-1384

Provider Business Practice Location Address
First Line	:	6515 BARRIE RD
Second Line	:	100
City	:	EDINA
State	:	MN
Zip	:	55435-2363
Country	:	US
Telephone Number	:	952-922-5019
Fax Number	:	952-922-1384

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

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	11/27/2019

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Directions to “ EMILY PAULINE NOLD PT” Practice Location

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