Individual
WADE DANIEL HALVORSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
923 HALE LAKE POINTE, GRAND RAPIDS, MN 55744-9615
(218) 326-0543
Mailing address
1911 OHIO AVE, SUPERIOR, WI 54880-2018
(952) 797-2457
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A2707
MN
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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