Provider Demographics
NPI:1861828824
Name:LONDEEN, MARIKA ELISABET (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:ELISABET
Last Name:LONDEEN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5357 COUNTY ROAD 82 NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8212
Mailing Address - Country:US
Mailing Address - Phone:952-270-0699
Mailing Address - Fax:
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2476261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy