Provider Demographics
NPI:1386769495
Name:EISENSCHENK, JULIE M (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:EISENSCHENK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26990 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-9611
Mailing Address - Country:US
Mailing Address - Phone:320-345-1924
Mailing Address - Fax:
Practice Address - Street 1:26990 163RD AVE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-9611
Practice Address - Country:US
Practice Address - Phone:320-345-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340C4EIOtherBCBS MN