Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | MN | |
Y | 225100000X | Physical Therapist | 8777 | MN |
NPI | 1003109943 |
---|---|
Provider Name | Maggie Lynn Morley Henjum |
First Address | Saint Paul, MN 55104-1033 |
Second Address | Saint Paul, MN 55104-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 21/06/2021 |