Provider Demographics
NPI:1891391314
Name:DYKHOFF, DEBRA LEE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:DYKHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 ROCKFORD AVE E
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9186
Mailing Address - Country:US
Mailing Address - Phone:612-419-7372
Mailing Address - Fax:
Practice Address - Street 1:795 ROCKFORD AVE E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-9186
Practice Address - Country:US
Practice Address - Phone:612-419-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMT3400737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist