Provider Demographics
NPI:1932767597
Name:BLIXT, NADINE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:LYNN
Last Name:BLIXT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 1ST ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1245
Mailing Address - Country:US
Mailing Address - Phone:218-885-1282
Mailing Address - Fax:218-885-1471
Practice Address - Street 1:832 1ST ST STE 140
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1245
Practice Address - Country:US
Practice Address - Phone:218-885-1282
Practice Address - Fax:218-885-1471
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC09346OtherMEDICARE
MN130020300Medicaid