Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8197 | MN |
NPI | 1053568634 |
---|---|
Provider Name | Heide Sue Slinde Baker |
First Address | Woodbury, MN 55125-4925 |
Second Address | Saint Paul, MN 55104-3733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 02/07/2015 |