Provider Demographics
NPI:1659564243
Name:BIRKHOLZ, DANA DEEANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:DEEANNE
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8005
Mailing Address - Country:US
Mailing Address - Phone:952-448-9081
Mailing Address - Fax:952-448-9088
Practice Address - Street 1:7872 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8005
Practice Address - Country:US
Practice Address - Phone:952-448-9081
Practice Address - Fax:952-448-9088
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8012225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8012OtherSTATE LICENSE NUMBER