Healthcare Provider Details

I. General information

NPI: 1760227995
Provider Name (Legal Business Name): REBECCA JEAN NARVERUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 BAILEY RD
WOODBURY MN
55129-9610
US

IV. Provider business mailing address

1660 HIGHWAY 100 S STE 103
ST LOUIS PARK MN
55416-1599
US

V. Phone/Fax

Practice location:
  • Phone: 651-209-9170
  • Fax:
Mailing address:
  • Phone: 763-531-5039
  • Fax: 651-458-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA1215
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: