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General NPI Number Information
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NPI Number | 1700566965
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Entity Type | Individual
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Provider Name | TY KARNES PTA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 4310 MENARD DR STE 400
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City | HERMANTOWN
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State | MN
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Zip | 55811-1565
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Country | US
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Telephone | 218-625-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 229 S 21ST AVE E
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City | DULUTH
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State | MN
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Zip | 55812-2105
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Country | US
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Telephone | 218-301-4751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A2886
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License Number State | MN
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