Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 12288 | MN |
NPI | 1033592472 |
---|---|
Provider Name | Naga Rumicho |
First Address | Minneapolis, MN 55408-3250 |
Second Address | Coon Rapids, MN 55433-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 24/06/2021 |