MEDICARE: ROSS B VAN NATTA MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT02693	RI
2	225100000X	Physical Therapist	7251	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609964782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSS B VAN NATTA MSPT

Provider Business Mailing Address
First Line	:	PO BOX 7197
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55903-7197
Country	:	US
Telephone Number	:	507-322-3460
Fax Number	:	507-322-3450

Provider Business Practice Location Address
First Line	:	3708 BROADWAY AVE N STE 110
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-4590
Country	:	US
Telephone Number	:	507-322-3460
Fax Number	:	507-322-3450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/23/2025

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Directions to “ ROSS B VAN NATTA MSPT” Practice Location

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