Provider Demographics
NPI:1003109943
Name:MORLEY HENJUM, MAGGIE LYNN (DPT, OCS, FAAOMPT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:LYNN
Last Name:MORLEY HENJUM
Suffix:
Gender:F
Credentials:DPT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:LYNN
Other - Last Name:HENJUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, OCS, FAAOMPT
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-348-7428
Mailing Address - Fax:651-348-7432
Practice Address - Street 1:1939 MINNEHAHA AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1033
Practice Address - Country:US
Practice Address - Phone:651-348-7428
Practice Address - Fax:651-348-7432
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225100000X
MN8777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist