Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7849 | MN |
N | 2251S0007X | Physical Therapist - Sports | 070.018314 | IL |
NPI | 1144311176 |
---|---|
Provider Name | David Doyle Jantzi |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Maple Grove, MN 55369-3464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 27/05/2016 |