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NPI Code Detail

MEDICARE: PAULINE MADRINICH PTA

MEDICARE:   PAULINE  MADRINICH  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1154381176
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINE MADRINICH PTA
Provider Business Mailing Address
First Line : 287 GROVES DR
Second Line :
City : CHASKA
State : MN
Zip : 55318-1570
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4010 W 65TH ST
Second Line : SUITE 105
City : EDINA
State : MN
Zip : 55435-1721
Country : US
Telephone Number : 952-285-2840
Fax Number : 952-285-2830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 07/08/2007

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Directions to “ PAULINE MADRINICH PTA” Practice Location

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