Provider Demographics
NPI:1831857770
Name:WANGERIN, EMILY (BS, PTA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WANGERIN
Suffix:
Gender:F
Credentials:BS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FRANCE AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2139
Mailing Address - Country:US
Mailing Address - Phone:952-924-5255
Mailing Address - Fax:
Practice Address - Street 1:6363 FRANCE AVE S STE 100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2139
Practice Address - Country:US
Practice Address - Phone:952-924-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2489225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant