| |
3395 Plymouth Rd Minnetonka MN 55305-3765 | |
(952) 939-0396 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 3395 Plymouth Rd, Minnetonka, Minnesota |
Authorized Official Name and Position | Julie Sjordal (CEO) |
Authorized Official Contact | 9529390396 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3395 Plymouth Rd Minnetonka MN 55305-3765 Ph: () - | 3395 Plymouth Rd Minnetonka MN 55305-3765 Ph: (952) 939-0396 |
NPI Number | 1376752337 |
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Provider Enumeration Date | 05/22/2007 |
Last Update Date | 04/07/2022 |
Certification Date | 04/07/2022 |
Medicare PECOS PAC ID | 8628292455 |
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Medicare Enrollment ID | O20140617000717 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376752337 | NPI | - | NPPES |
426345600 | Medicaid | MN |
Provider Name | Joan M Trieff |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1679070783 PECOS PAC ID: 6608262696 Enrollment ID: I20240703003314 |
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