Provider Demographics
NPI:1871880443
Name:MCCABE, MARIE JEAN (DPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JEAN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:JEAN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:4791 COUNTY ROAD 10 STE 102
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9221
Practice Address - Country:US
Practice Address - Phone:218-485-2020
Practice Address - Fax:218-485-2044
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist