Provider Demographics
NPI:1528135019
Name:HAROLDSON, JODI S (PT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:HAROLDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:SOLIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 CENTRAL AVE N
Practice Address - Street 2:SUITE LL-10
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1206
Practice Address - Country:US
Practice Address - Phone:952-993-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist