MEDICARE: MR. MARK THOMAS RATTRAY P.T.

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	2626	MN

General Provider Information

NPI Number	:	1699743757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK THOMAS RATTRAY P.T.

Provider Business Mailing Address
First Line	:	2700 EAST LAKE STREET
Second Line	:	SUITE 2450
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2690
Country	:	US
Telephone Number	:	612-436-0777
Fax Number	:	612-436-0779

Provider Business Practice Location Address
First Line	:	2700 EAST LAKE STREET
Second Line	:	SUITE 2450
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2690
Country	:	US
Telephone Number	:	612-436-0777
Fax Number	:	612-436-0779

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/23/2015

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