Provider Demographics
NPI:1376328401
Name:AIGNER, ELLEN GRACE
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:GRACE
Last Name:AIGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CHET DR
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1838
Mailing Address - Country:US
Mailing Address - Phone:701-640-9538
Mailing Address - Fax:
Practice Address - Street 1:3007 HIGHWAY 29 S STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3400
Practice Address - Country:US
Practice Address - Phone:320-460-1188
Practice Address - Fax:320-310-0423
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2833225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant