Healthcare Provider Details

I. General information

NPI: 1912421314
Provider Name (Legal Business Name): JARED M UNDERRINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S OAK AVE STE 2
OWATONNA MN
55060-3957
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-8254
  • Fax: 507-451-7324
Mailing address:
  • Phone: 507-322-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12936
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: