Individual
DIANE MARIE EIDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
3400 W 66TH ST, SUITE 150, EDINA, MN 55435-2109
(952) 920-8088
(763) 302-4219
Mailing address
3400 W 66TH ST, SUITE 150, EDINA, MN 55435-2109
(952) 920-8088
(763) 302-4219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
653
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10A51EI
BCBS OF MN
MN
01
—
6429736
MEDICA
MN
01
—
793845
AMERICA'S PPO
MN
01
—
962871010735
PREFERRED ONE
MN
01
—
HP44376
HEALTHPARTNERS
MN
Enumeration date
07/23/2006
Last updated
12/06/2011
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