Healthcare Provider Details

I. General information

NPI: 1366377178
Provider Name (Legal Business Name): TEASHA ARCHAMBAULT PT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 GUERNSEY LN
RED WING MN
55066-7415
US

IV. Provider business mailing address

395 GUERNSEY LN
RED WING MN
55066-7415
US

V. Phone/Fax

Practice location:
  • Phone: 651-388-4441
  • Fax:
Mailing address:
  • Phone: 651-388-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7499
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: