Most Relevant Information
Provider Data
| NPI Number: | 1003436346 |
| Provider Name: | JENNIFER GORDON HAKES PT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 6175 |
Most Important Dates
| Enumeration Date: | 04/16/2020 |
| Last Updated: | 04/16/2020 |
Provider Practice Location
4050 COON RAPIDS BLVD NW
COON RAPIDS
MN
554332522
Practice Location Phone/Fax
| Phone: | 7632368910 |
| Fax: | 7632368990 |
Provider Mailing Location
4050 COON RAPIDS BLVD NW
COON RAPIDS
MN
554332522
Provider Mailing Phone/Fax
| Phone: | 7632368910 |
| Fax: | 7632368990 |