Provider Demographics
NPI:1568562585
Name:BRIGGS, MARY JO (RPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18438 246TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 SUNSET AVE NW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-9620
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP45705OtherHEALTH PARTNERS
MN14D28BROtherBLUE CROSS BLUE SHIELD
MN6407248OtherMEDICA
MN246533Medicare ID - Type UnspecifiedHEALTH DIMENSIONS REHAB