Healthcare Provider Details

I. General information

NPI: 1972028793
Provider Name (Legal Business Name): ERIC GRABER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 GOLF COURSE RD
GRAND RAPIDS MN
55744-8681
US

IV. Provider business mailing address

7551 9TH ST N STE 100
OAKDALE MN
55128-6628
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-7776
  • Fax:
Mailing address:
  • Phone: 651-747-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6978
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: