Provider Demographics
NPI:1104494608
Name:SWANSON, ALYSSA MARIE MESEDAHL (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE MESEDAHL
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:MESEDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:2701 W SUPERIOR ST STE 112
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1885
Practice Address - Country:US
Practice Address - Phone:218-727-1180
Practice Address - Fax:844-856-3737
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12404225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist