MEDICARE: TOM S ROTMAN

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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1982279683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM S ROTMAN

Provider Business Mailing Address
First Line	:	4021 VERNON AVE S STE 210
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2802
Country	:	US
Telephone Number	:	612-486-2612
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 VERNON AVE S STE 210
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2802
Country	:	US
Telephone Number	:	612-486-2612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ TOM S ROTMAN ” Practice Location

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