Mary T Outpatient

NPI #1396475927 in Coon Rapids, Minnesota

Provider Information

NPI Number: 1396475927
Entity Type: Organization
Organization Name: Mary T Outpatient
Primary Specialty: Physical Therapist
Enumeration Date: Jun 15, 2022
Last Updated: Jun 24, 2022

Practice Location

Address: 11800 XEON BLVD NW
City: Coon Rapids
State: Minnesota
ZIP Code: 55448-2061
Phone: (763) 489-3638

Authorized Official

Name: JASON TJOSVOLD
Title: CHIEF ADMINISTRATIVE OFFICER
Phone: (763) 567-8951

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Physical Therapist	225100000X	Primary

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