Sandra Soderberg, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

1353 Issued in MN

Practice address

2040 Douglas Dr N
Suite 203
Golden Valley, MN 55422-3944

Phone

(763) 525-9566

Fax

(763) 544-2180

NPI assigned

Sep 25, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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": "1144321159",
    "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": "763-525-9566",
            "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": "763-525-9566",
            "fax_number": "763-544-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERBERG",
        "first_name": "SANDRA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MN",
            "license": "1353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "641948",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "036J0SO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173205",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289017800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "123593400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Smith, PSY.D
• Trizer Smith
• Snap Medical Supply LLC
• Soderberg Physical Therapy LLC
• Eldon Soderberg, PT
• Andrew Yu Song, L.AC.
• Soul Centered Therapy, LLC
• Madeleine Spalding, LADC
• Spectrum Roots LLC
• Kara Jo Speidel, MSOTR/L

• Orthopedic Physical Therapist in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Orthopedic Physical Therapist in Minnesota

• 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.

Verify at the official NPI Registry.