Individual
MRS. AMY RENEE WILLINGHAM
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHYSICALTHERAPISTMPT
Contact information
Practice address
1620 17TH ST NW, FARIBAULT, MN 55021-2839
(507) 332-2204
(507) 332-2270
Mailing address
16827 INTERLACHEN BLVD, LAKEVILLE, MN 55044-4639
(952) 431-6341
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5888
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110J8WI
BCBS IND PROVIDER #
MN
01
—
116113
U-CARE PROVIDER #
MN
01
—
236065
ARAZ PROVIDER #
MN
01
—
6402283
MEDICA INDIVIDUAL PROV #
MN
01
—
HP41242
HEALTH PARTNERS PROV #
MN
Enumeration date
02/10/2006
Last updated
07/09/2007
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