Healthcare Provider Details

I. General information

NPI: 1508185463
Provider Name (Legal Business Name): CHAD ALAN BARIBEAU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 06/10/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 HIGHWAY 110
AURORA MN
55705-1522
US

IV. Provider business mailing address

SSB-6 400 E 3RD ST.
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-229-3311
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6361
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: