Basic Information
| Provider Information | |||||||||
| NPI: | 1447465935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDDOW VAN ERP | ||||||||
| FirstName: | JANELLE | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36907 S SILVER LAKE RD | ||||||||
| Address2: | |||||||||
| City: | BATTLE LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565159108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186401121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 INMAN ST | ||||||||
| Address2: | |||||||||
| City: | HENNING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565514102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185485580 | ||||||||
| FaxNumber: | 2186328765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5306 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.