Provider Demographics
NPI:1295003135
Name:SJURSETH, CINDY MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:MARIE
Last Name:SJURSETH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 285TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4357
Mailing Address - Country:US
Mailing Address - Phone:763-389-5423
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:MN
Practice Address - Zip Code:55005
Practice Address - Country:US
Practice Address - Phone:763-269-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA640225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant