Provider Demographics
NPI:1043441553
Name:SUNDQUIST, JOHN ALLEN (CMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
Last Name:SUNDQUIST
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1980
Mailing Address - Country:US
Mailing Address - Phone:612-669-7755
Mailing Address - Fax:952-931-9578
Practice Address - Street 1:684 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1980
Practice Address - Country:US
Practice Address - Phone:612-669-7755
Practice Address - Fax:952-931-9578
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist