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NPI Code Detail

MEDICARE: LEE MYRDAL

MEDICARE: LEE MYRDAL
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
1225200000XPhysical Therapy AssistantA2317MN

General Provider Information

NPI Number : 1366156234
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE MYRDAL
Provider Business Mailing Address
First Line : 111 MARQUETTE AVE APT 1212
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2029
Country : US
Telephone Number : 218-341-3680
Fax Number :
Provider Business Practice Location Address
First Line : 275 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1216
Country : US
Telephone Number : 612-377-4723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2023
Last Update Date : 01/05/2023

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Directions to “ LEE MYRDAL ” Practice Location

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