Provider Demographics
NPI:1245898584
Name:TORDSEN, JESSE JOHNSON (CMT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:JOHNSON
Last Name:TORDSEN
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 1:2302 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3325
Mailing Address - Country:US
Mailing Address - Phone:952-457-7814
Mailing Address - Fax:
Practice Address - Street 1:2937 LYNDALE AVE S STE 201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2177
Practice Address - Country:US
Practice Address - Phone:952-457-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist