Basic Information
| Provider Information | |||||||||
| NPI: | 1710930714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENGELMANN | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7541 9TH ST N | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551286626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517484338 | ||||||||
| FaxNumber: | 6517482892 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 2ND ST NE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HOPKINS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553438587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529369600 | ||||||||
| FaxNumber: | 9519369536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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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 | 1685 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 992245800 | 05 | MN | MEDICAID | HP27933 | 01 | MN | HEALTHPARTNERS | OTHER | 198K2HE | 01 | MN | BLUECROSS BLUESHEILD | OTHER | 6402608 | 01 | MN | MEDICA | OTHER |