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General NPI Number Information
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NPI Number | 1578294484
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Entity Type | Organization
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Legal Business Name | TRIA ORTHOPAEDIC CENTER
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 8100 NORTHLAND DR
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City | BLOOMINGTON
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State | MN
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Zip | 55431-4800
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Country | US
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Telephone | 952-993-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 2186 BANEBERRY WAY W
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City | CHANHASSEN
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State | MN
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Zip | 55317-8338
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ANTHONY TATUM
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Credential |
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Telephone | 952-993-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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