Provider Demographics
NPI:1417326265
Name:BERTELSEN, JULIANA FRANCINE (LMT)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:FRANCINE
Last Name:BERTELSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 VINEWOOD AVENUE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:218-591-0748
Mailing Address - Fax:
Practice Address - Street 1:2001 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1120
Practice Address - Country:US
Practice Address - Phone:218-591-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist