Provider Demographics
NPI:1538715396
Name:BRODKE, HANNAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BRODKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN STE 120
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5338
Mailing Address - Country:US
Mailing Address - Phone:952-300-3493
Mailing Address - Fax:763-260-7653
Practice Address - Street 1:707 BIELENBERG DR STE 108
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1427
Practice Address - Country:US
Practice Address - Phone:651-846-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist