Provider Demographics
NPI:1548580699
Name:CHRISTENSEN, MIKAYLA
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:TAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 KING ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-9786
Mailing Address - Country:US
Mailing Address - Phone:701-740-4771
Mailing Address - Fax:
Practice Address - Street 1:616 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1380
Practice Address - Country:US
Practice Address - Phone:320-585-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist