Doctor Name: | JONI VANSELOW |
NPI Number: | 1891796124 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 2169 |
Business Practice Address: | 4010 W 65th St Suite 105 Edina, MN - 554351721 |
Business Phone Number: | 9522852840 |
Business Fax Number: | 9522852830 |
Mailing Address: | 6933 Black Duck Dr, LINO LAKES |
State: | MN |
Postal Code: | 550141319 |
Phone Number: | 6514268830 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 2169 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |