Provider Demographics
NPI:1134168404
Name:QUADE, JOSEPH URBAN (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:URBAN
Last Name:QUADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N BLACKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5239
Mailing Address - Country:US
Mailing Address - Phone:218-341-1205
Mailing Address - Fax:
Practice Address - Street 1:1204 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1622
Practice Address - Country:US
Practice Address - Phone:218-878-0805
Practice Address - Fax:218-878-0794
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN006R1QUOtherBLUE CROSS BLUE SHIELD
MN561258600Medicaid
MN561258600Medicaid