Healthcare Provider Details

I. General information

NPI: 1770490120
Provider Name (Legal Business Name): BRYAN PERALTA GARCES DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16550 W 78TH ST STE B
EDEN PRAIRIE MN
55346-4316
US

IV. Provider business mailing address

7872 CENTURY BLVD
CHANHASSEN MN
55317-8005
US

V. Phone/Fax

Practice location:
  • Phone: 952-873-7400
  • Fax: 952-873-7408
Mailing address:
  • Phone: 952-873-7400
  • Fax: 952-873-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14473
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: