Healthcare Provider Details

I. General information

NPI: 1215592035
Provider Name (Legal Business Name): SARINA ROSE MCNEILL PT,DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARINA ROSE GOOS PT

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 VILLAGE WAY STE 100
WACONIA MN
55387-4612
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-2960
  • Fax:
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13244
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: