Provider Demographics
NPI:1083069215
Name:RORVIG, GABE (ATC, EMT)
Entity Type:Individual
Prefix:MR
First Name:GABE
Middle Name:
Last Name:RORVIG
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E MAIN ST
Mailing Address - Street 2:APT C
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4690
Mailing Address - Country:US
Mailing Address - Phone:507-251-3410
Mailing Address - Fax:
Practice Address - Street 1:521 E MAIN ST
Practice Address - Street 2:APT C
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4690
Practice Address - Country:US
Practice Address - Phone:507-251-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20000224012255A2300X
MNE2036958146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic