MEDICARE: MARK R DESCHEPPER 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	2251X0800X	Orthopedic Physical Therapist	10354	MN
2	225100000X	Physical Therapist	10354	MN

General Provider Information

NPI Number	:	1437603016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK R DESCHEPPER PT

Provider Business Mailing Address
First Line	:	20445 DONNELLY AVE
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-9049
Country	:	US
Telephone Number	:	651-363-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 147TH ST W STE 403
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-4515
Country	:	US
Telephone Number	:	651-363-1449
Fax Number	:	651-377-5326

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

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	03/10/2026

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