Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 10027 | MN |
Y | 2251P0200X | Physical Therapist - Pediatrics | 10027 | MN |
NPI | 1225483365 |
---|---|
Provider Name | Maria Leider |
First Address | Burnsville, MN 55337 |
Second Address | Burnsville, MN 55337-6868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 06/04/2020 |