Healthcare Provider Details

I. General information

NPI: 1164972576
Provider Name (Legal Business Name): DREW PARADIS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E STE 101
ALEXANDRIA MN
56308-3734
US

IV. Provider business mailing address

1609 SCENIC HEIGHTS RD NE
ALEXANDRIA MN
56308-8694
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1144
  • Fax:
Mailing address:
  • Phone: 320-815-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10283
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: