Individual
JESSICA BLAISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
75 VIKING DR W STE 101, LITTLE CANADA, MN 55117-1778
(651) 756-7941
Mailing address
270 72ND ST N, MAHTOMEDI, MN 55115-2079
(651) 497-6997
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11600
MN
Other
Enumeration date
01/16/2020
Last updated
08/31/2021
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