Healthcare Provider Details

I. General information

NPI: 1255420238
Provider Name (Legal Business Name): KATHY SUE TRAUTMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY SUE HABERER PTA

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

9101 OLD CEDAR AVE S #204
BLOOMINGTON MN
55425-2341
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: