Individual
MARDON ELLEN SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
515 5TH AVE W, GRAND MARAIS, MN 55604-3017
(218) 387-3040
Mailing address
515 5TH AVE W, GRAND MARAIS, MN 55604-3017
(218) 387-3040
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13275
MN
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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