Healthcare Provider Details

I. General information

NPI: 1265763395
Provider Name (Legal Business Name): MRS. TRACY FOLEY-TONSAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-4330
  • Fax: 612-904-4330
Mailing address:
  • Phone: 612-873-4330
  • Fax: 612-904-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4951
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: