Provider Demographics
NPI:1326410341
Name:JUNG, MICHELLE LINAE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LINAE
Last Name:JUNG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7942 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3501
Mailing Address - Country:US
Mailing Address - Phone:952-334-6806
Mailing Address - Fax:
Practice Address - Street 1:622 ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-9516
Practice Address - Country:US
Practice Address - Phone:952-492-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist