Healthcare Provider Details

I. General information

NPI: 1285822650
Provider Name (Legal Business Name): ERIC ROMAN PAUR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR TRIA ORTHOPAEDIC CENTER
BLOOMINGTON MN
55431-4800
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-806-5616
  • Fax: 952-806-5510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8041
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: