Basic Information
| Provider Information | |||||||||
| NPI: | 1003041575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGIUDICE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | REIF | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23950 MANNING TRL N | ||||||||
| Address2: | |||||||||
| City: | SCANDIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550739528 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9220 BASS LAKE RD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | NEW HOPE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554283000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635330363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5243 | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | 5243 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.