Provider Demographics
NPI:1013149319
Name:OPDAHL, DIANE KAY (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:OPDAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10903 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3420
Mailing Address - Country:US
Mailing Address - Phone:952-933-1150
Mailing Address - Fax:952-930-3304
Practice Address - Street 1:10903 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3420
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:952-930-3304
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist