Individual
NATHAN A MOLDESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
200 8TH AVE NW, SUITE 4, FARIBAULT, MN 55021-5068
(507) 334-5627
(507) 334-1824
Mailing address
200 8TH AVE NW, SUITE 4, FARIBAULT, MN 55021-5068
(507) 334-5627
(507) 334-1824
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7907
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230D7MO
MN BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/11/2007
Last updated
07/12/2007
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