Provider Demographics
NPI:1881780336
Name:WEDEL, ANN (PT PHYSICAL THERAPIS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WEDEL
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1814
Mailing Address - Country:US
Mailing Address - Phone:218-927-6500
Mailing Address - Fax:
Practice Address - Street 1:515 6TH AVE SE
Practice Address - Street 2:757 RAYMOND AVE, SUITE 204, ST PAUL, MN 55114
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1814
Practice Address - Country:US
Practice Address - Phone:218-927-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist