Provider Demographics
NPI:1780963751
Name:ENGBERG, MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ENGBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 FRANCE AVE S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4305
Mailing Address - Country:US
Mailing Address - Phone:952-285-2840
Mailing Address - Fax:952-285-2830
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 305
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-2830
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87932251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics