Provider Demographics
NPI: | 1194238287 |
---|---|
Name: | MORAN, TUOMAS ALEKSI (PT, DPT, ATC, LAT) |
Entity type: | Individual |
Prefix: | DR |
First Name: | TUOMAS |
Middle Name: | ALEKSI |
Last Name: | MORAN |
Suffix: | |
Gender: | M |
Credentials: | PT, DPT, ATC, LAT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2203 FULHAM ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ROSEVILLE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55113-3816 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-757-6518 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 535 HOSPITAL RD |
Practice Address - Street 2: | |
Practice Address - City: | NEW RICHMOND |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54017-1449 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-243-2760 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-11-10 |
Last Update Date: | 2017-11-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 10774 | 225100000X |
MN | 2615 | 2255A2300X |
WI | 2022-39 | 2255A2300X |
WI | 13991-24 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |