Provider Demographics
NPI:1205950607
Name:ISERNHAGEN, DENNIS DEAN (PT)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DEAN
Last Name:ISERNHAGEN
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 1:130 W SUPERIOR ST
Mailing Address - Street 2:SUITE 625
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2032
Mailing Address - Country:US
Mailing Address - Phone:218-625-1051
Mailing Address - Fax:218-625-1052
Practice Address - Street 1:130 W SUPERIOR ST
Practice Address - Street 2:SUITE 625
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2032
Practice Address - Country:US
Practice Address - Phone:218-625-1051
Practice Address - Fax:218-625-1052
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist