Active NPI
Eldon Soderberg, PT
- Orthopedic Physical Therapist
- Golden Valley, MN
National Provider Identifier
1104927169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 1821
- Practice address
- 2040 Douglas Dr N
Suite 203
Golden Valley, MN 55422-3944 - Phone
- (763) 925-9566
- Fax
- (763) 544-2180
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 1821 | MN | Primary |
Addresses
Primary practice location
2040 Douglas Dr N
Suite 203
Golden Valley, MN 55422-3944
Mailing address
2040 Douglas Dr N
Suite 203
Golden Valley, MN 55422-3944
Phone (763) 925-9566
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 035J9SO | Other | MN | MN BCBS |
| 370085200 | Medicaid | MN | |
| 123593400 | Other | MN | US DEPT OF LABOR |
| 173205 | Medicaid | MN | |
| 6401945 | Other | MN | MEDICA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1821 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1104927169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2040 DOUGLAS DR N",
"address_2": "SUITE 203",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554223944",
"telephone_number": "763-925-9566",
"fax_number": "763-544-2180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 DOUGLAS DR N",
"address_2": "SUITE 203",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554223944",
"telephone_number": "763-925-9566",
"fax_number": "763-544-2180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODERBERG",
"first_name": "ELDON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "MN",
"license": "1821",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS",
"identifier": "035J9SO",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "370085200",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "123593400",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "173205",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6401945",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Golden Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.