Provider Demographics
NPI:1083707046
Name:HJELM, FREDERICK CARL (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:CARL
Last Name:HJELM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2832
Mailing Address - Country:US
Mailing Address - Phone:763-784-3155
Mailing Address - Fax:763-784-2352
Practice Address - Street 1:1835 COUNTY ROAD C W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1352
Practice Address - Country:US
Practice Address - Phone:651-638-0080
Practice Address - Fax:651-638-0082
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5873789-00Medicaid
MN5873789-00Medicaid