Healthcare Provider Details

I. General information

NPI: 1861304693
Provider Name (Legal Business Name): NISHTA PATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N 1ST ST
MINNEAPOLIS MN
55401-5400
US

IV. Provider business mailing address

110 N 1ST ST
MINNEAPOLIS MN
55401-5400
US

V. Phone/Fax

Practice location:
  • Phone: 872-367-9828
  • Fax:
Mailing address:
  • Phone: 872-367-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3202
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: