Provider Demographics
NPI:1174045884
Name:RAYMOND, TRISTA LEE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:LEE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:LEE
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2551 38TH AVE NE UNIT 322
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-5013
Mailing Address - Country:US
Mailing Address - Phone:320-894-8944
Mailing Address - Fax:
Practice Address - Street 1:3580 ARCADE ST
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7135
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist