Provider Demographics
NPI:1447465935
Name:BEDDOW VAN ERP, JANELLE R
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:R
Last Name:BEDDOW VAN ERP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36907 S SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-9108
Mailing Address - Country:US
Mailing Address - Phone:218-640-1121
Mailing Address - Fax:
Practice Address - Street 1:801 INMAN ST
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4102
Practice Address - Country:US
Practice Address - Phone:218-548-5580
Practice Address - Fax:218-632-8765
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist