Provider Demographics
NPI:1699743757
Name:RATTRAY, MARK THOMAS (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:RATTRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 EAST LAKE STREET
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2690
Mailing Address - Country:US
Mailing Address - Phone:612-436-0777
Mailing Address - Fax:612-436-0779
Practice Address - Street 1:2700 EAST LAKE STREET
Practice Address - Street 2:SUITE 2450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2690
Practice Address - Country:US
Practice Address - Phone:612-436-0777
Practice Address - Fax:612-436-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist