Basic Information
| Provider Information | |||||||||
| NPI: | 1881971794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENBERG | ||||||||
| FirstName: | RESADA | ||||||||
| MiddleName: | KATHRYN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 E COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562582065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075321940 | ||||||||
| FaxNumber: | 5075321176 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 EAST COLLEGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562580000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202265739 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2011 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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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 | 2255A2300X | 2187 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 208100000X | 10378 | MN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.