Healthcare Provider Details

I. General information

NPI: 1477528032
Provider Name (Legal Business Name): ROBERT A ELVERU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 RAILROAD DR NW SUITE 102
ELK RIVER MN
55330-1463
US

IV. Provider business mailing address

9943 165TH AVE NW
ELK RIVER MN
55330-6301
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-8111
  • Fax: 763-441-9015
Mailing address:
  • Phone: 763-424-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2031
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: