Provider Demographics
NPI:1144352873
Name:IDELKOPE, MARIE ELISE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELISE
Last Name:IDELKOPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELISE
Other - Last Name:LIEKHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:410 CHURCH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0222
Mailing Address - Country:US
Mailing Address - Phone:612-625-8400
Mailing Address - Fax:612-677-3321
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0222
Practice Address - Country:US
Practice Address - Phone:612-625-8400
Practice Address - Fax:612-677-3321
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist