Healthcare Provider Details

I. General information

NPI: 1497741847
Provider Name (Legal Business Name): TROY A VAN ORMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 ROWE AVE
WORTHINGTON MN
56187-9700
US

IV. Provider business mailing address

1530 ROWE AVE
WORTHINGTON MN
56187-9700
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-2232
  • Fax: 507-372-7326
Mailing address:
  • Phone: 507-372-2232
  • Fax: 507-372-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5980
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0742
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03343
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: