Provider Demographics
NPI:1962076117
Name:GJERDE, HANNAH ROSE (DPT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:GJERDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ROSE
Other - Last Name:KINGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 MINNESOTA AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4485
Mailing Address - Country:US
Mailing Address - Phone:320-231-4175
Mailing Address - Fax:320-231-4575
Practice Address - Street 1:300 MINNESOTA AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4485
Practice Address - Country:US
Practice Address - Phone:320-231-4175
Practice Address - Fax:320-231-4575
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist