Provider Demographics
NPI:1508233230
Name:SOFFA, JENNIFER LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAUREN
Last Name:SOFFA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:1000 W 140TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4480
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-3001
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2021-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist