Individual
DR. MICHELLE A UGALDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT-DPT
Contact information
Practice address
1660 HIGHWAY 100 SOUTH, SUITE 145, ST. LOUIS PARK, MN 55416-1562
(952) 456-6160
(952) 456-6184
Mailing address
1660 HIGHWAY 100 SOUTH, SUITE 145, ST. LOUIS PARK, MN 55416-1562
(952) 456-6160
(952) 456-6184
Taxonomy
Speciality
Code
Description
License number
State
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
Primary
9157
MN
225100000X
Physical Therapist
9157
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650002921
MEDICARE PTAN
MN
01
—
C09200
GROUP PTAN
MN
01
—
C09271
MEDICARE PTAN
MN
Enumeration date
09/20/2012
Last updated
04/03/2013
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