Basic Information
Provider Information
NPI: 1053568634
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SLINDE BAKER
FirstName: HEIDE
MiddleName: SUE
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SLINDE
OtherFirstName: HEIDE
OtherMiddleName: SUE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 1
Mailing Information
Address1: 710 COMMERCE DR STE 200
Address2:  
City: WOODBURY
State: MN
PostalCode: 551254925
CountryCode: US
TelephoneNumber: 6519685042
FaxNumber: 6519685904
Practice Location
Address1: 1661 SAINT ANTHONY AVE
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551043733
CountryCode: US
TelephoneNumber: 6519685335
FaxNumber: 6517303989
Other Information
ProviderEnumerationDate: 08/26/2008
LastUpdateDate: 07/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X8197MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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