Healthcare Provider Details

I. General information

NPI: 1477645059
Provider Name (Legal Business Name): GARY OLTMANNS RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 E RUM RIVER DR S
CAMBRIDGE MN
55008-2663
US

IV. Provider business mailing address

3433 COUNTY ROAD 5
BARNUM MN
55707-8747
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1715
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: