Healthcare Provider Details

I. General information

NPI: 1689066375
Provider Name (Legal Business Name): SUSAN RADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH ST NW STE 200
ROCHESTER MN
55901-6606
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax: 307-856-5545
Mailing address:
  • Phone: 507-322-3460
  • Fax: 307-856-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4653
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: