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General NPI Number Information
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NPI Number | 1255897765
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Entity Type | Organization
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Legal Business Name | DR. TOM TARDIF, LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 510 22ND AVE E STE 602
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City | ALEXANDRIA
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State | MN
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Zip | 56308-1978
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Country | US
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Telephone | 320-808-9323
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Fax |
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Provider Business Mailing Address
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Address Line | 524 E LAKE COWDRY RD NW
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City | ALEXANDRIA
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State | MN
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Zip | 56308-8126
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Country | US
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Telephone | 320-808-9323
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Fax |
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Authorized Official
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Title or Position | OWNER/PT
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Name | THOMAS TARDIF
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Credential | DPT
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Telephone | 612-643-0019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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