Provider Demographics
NPI:1912322835
Name:JORGENSON, REBECCA A (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-373-5720
Mailing Address - Fax:
Practice Address - Street 1:11995 SINGLETREE LN
Practice Address - Street 2:SUITE 120
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5347
Practice Address - Country:US
Practice Address - Phone:952-373-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90732251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports