Provider Demographics
NPI:1780963850
Name:NEISEN, SAUNDRA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:MARIE
Last Name:NEISEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:MARIE
Other - Last Name:MOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8770 TAMARACK ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5958
Mailing Address - Country:US
Mailing Address - Phone:330-575-7516
Mailing Address - Fax:
Practice Address - Street 1:825 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6846
Practice Address - Country:US
Practice Address - Phone:651-633-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist