Provider Demographics
NPI:1881254506
Name:TUTTLE, EMILY NICOLE PECK (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE PECK
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 MAJOR AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3139
Mailing Address - Country:US
Mailing Address - Phone:320-815-4219
Mailing Address - Fax:
Practice Address - Street 1:15600 36TH AVE N STE 120
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3687
Practice Address - Country:US
Practice Address - Phone:763-595-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics