Provider Demographics
NPI:1518636158
Name:SWENSEN, MIRANDA BIEGON (DPT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:BIEGON
Last Name:SWENSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:BIEGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3148 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1922
Mailing Address - Country:US
Mailing Address - Phone:801-759-1478
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DR N STE 313
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49866702401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist