Healthcare Provider Details

I. General information

NPI: 1568306645
Provider Name (Legal Business Name): ROSHAY GATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 N CRAILSHEIM RD
WORTHINGTON MN
56187-9409
US

IV. Provider business mailing address

671 N CRAILSHEIM RD
WORTHINGTON MN
56187-9409
US

V. Phone/Fax

Practice location:
  • Phone: 507-727-1275
  • Fax: 507-727-1277
Mailing address:
  • Phone: 507-727-1275
  • Fax: 507-727-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0105107
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: