Provider Demographics
NPI:1003876749
Name:AFFELDT, MARGARET ALICE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ALICE
Last Name:AFFELDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10589 64TH CT SE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-4606
Mailing Address - Country:US
Mailing Address - Phone:320-743-3827
Mailing Address - Fax:
Practice Address - Street 1:214 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1602
Practice Address - Country:US
Practice Address - Phone:763-682-8457
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist