Wade Daniel Halvorsen

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A2707 Issued in MN

Practice address

923 Hale Lake Pointe
Grand Rapids, MN 55744-9615

Phone

(218) 326-0543

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1952077901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 OHIO AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802018",
            "telephone_number": "952-797-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 HALE LAKE POINTE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449615",
            "telephone_number": "218-326-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVORSEN",
        "first_name": "WADE",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A2707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Theodore Hagley, DDS
• Jody J Hahn, OTR
• Heidi Halker
• Erick Michael Hallie, D.D.S.
• Valerie Halverson, R.PH.
• Anne Hammann, LADC
• Kayla Marie Hanna, MS, LPCC
• Rochelle Lois Hansen
• Jayce Hapka, AU.D.
• Michael Harbin, LICSW

• Physical Therapy Assistant in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.