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General NPI Number Information
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NPI Number | 1922958610
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Entity Type | Individual
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Provider Name | RAYMOND JOHN FABIAN JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 1 THOMPSON AVE W
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City | WEST ST PAUL
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State | MN
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Zip | 55118-3100
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Country | US
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Telephone | 651-259-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 10230 REDWOOD ST NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5153
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Country | US
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Telephone | 763-227-1982
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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 | A745
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License Number State | MN
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