Provider Demographics
NPI:1760853501
Name:TONSAGER, KATHERINE (P T)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:TONSAGER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SELBITSCHKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:P T
Mailing Address - Street 1:3915 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4249
Mailing Address - Country:US
Mailing Address - Phone:612-775-2822
Mailing Address - Fax:612-262-6732
Practice Address - Street 1:3915 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4249
Practice Address - Country:US
Practice Address - Phone:612-775-2822
Practice Address - Fax:612-262-6732
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist