Individual
HEIDI IVESDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
500 10TH AVE E, WEST FARGO, ND 58078-3060
(701) 356-2030
(701) 356-2039
Mailing address
500 10TH AVE E, WEST FARGO, ND 58078-3060
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1064
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50880
—
ND
Enumeration date
04/01/2008
Last updated
04/01/2008
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