Provider Demographics
NPI:1487650438
Name:FREDIN, TRUDY K (PT)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:K
Last Name:FREDIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 COUNTY ROAD 42 W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6913
Mailing Address - Country:US
Mailing Address - Phone:952-898-9191
Mailing Address - Fax:952-898-9101
Practice Address - Street 1:2140 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6913
Practice Address - Country:US
Practice Address - Phone:952-898-9191
Practice Address - Fax:952-898-9101
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4261OtherSTATE LICENSE