Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5837 | MN |
NPI | 1124133376 |
---|---|
Provider Name | Traci Marie Arens |
First Address | Stillwater, MN 55082-4529 |
Second Address | Saint Paul, MN 55118-3189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |