Provider Demographics
NPI:1124431481
Name:AMUNDSON, JOHN E (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:E
Other - Last Name:AMUNDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:410 30TH AVE E STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4770
Mailing Address - Country:US
Mailing Address - Phone:320-763-5505
Mailing Address - Fax:320-763-4447
Practice Address - Street 1:410 30TH AVE E STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4770
Practice Address - Country:US
Practice Address - Phone:320-763-5505
Practice Address - Fax:320-763-4447
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN95942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-2017731OtherGROUP NPI # 1184700924