Most Relevant Information
Provider Data
| NPI Number: | 1003587411 |
| Provider Name: | MARIA ANNE JACENKO PT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 4536 |
Most Important Dates
| Enumeration Date: | 09/24/2021 |
| Last Updated: | 01/13/2022 |
Provider Practice Location
724 MAPLE GROVE RD
DULUTH
MN
558114521
Practice Location Phone/Fax
| Phone: | 2187244900 |
| Fax: |
Provider Mailing Location
500 CROSS ST
BIG STONE CITY
SD
572168237
Provider Mailing Phone/Fax
| Phone: | 6055411140 |
| Fax: |