Provider Demographics
NPI:1184682650
Name:PAULSEN, TONYA JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:JANE
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6700
Practice Address - Fax:507-388-8372
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31B87BEOtherBCBS OF MN
MN103183C572OtherUCARE MN
MN6407047OtherMEDICA
MNH018OtherTRICARE
MNHP32896OtherHEALTH PARTNERS
MN983181027668OtherPREFERRED ONE