Provider Demographics
NPI:1659805745
Name:SORTEDAHL-LOPAC, MAGGIE SARAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:SARAH
Last Name:SORTEDAHL-LOPAC
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:SARAH
Other - Last Name:LOPAC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:412 QUINMORE AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-9647
Mailing Address - Country:US
Mailing Address - Phone:651-278-2441
Mailing Address - Fax:
Practice Address - Street 1:2800 CHICAGO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1318
Practice Address - Country:US
Practice Address - Phone:612-863-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist