Provider Demographics
NPI:1831440650
Name:UGALDE, MICHELLE A (PT-DPT)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:UGALDE
Suffix:
Gender:F
Credentials:PT-DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 SOUTH
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1562
Mailing Address - Country:US
Mailing Address - Phone:952-456-6160
Mailing Address - Fax:952-456-6184
Practice Address - Street 1:1660 HIGHWAY 100 SOUTH
Practice Address - Street 2:SUITE 145
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1562
Practice Address - Country:US
Practice Address - Phone:952-456-6160
Practice Address - Fax:952-456-6184
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9157225100000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650002921OtherMEDICARE PTAN
MNC09200OtherGROUP PTAN
MNC09271OtherMEDICARE PTAN