Provider Demographics
NPI:1225024607
Name:STAI, TIMOTHY S (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:STAI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ROWE AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-9700
Mailing Address - Country:US
Mailing Address - Phone:507-372-2232
Mailing Address - Fax:507-372-7326
Practice Address - Street 1:1530 ROWE AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-9700
Practice Address - Country:US
Practice Address - Phone:507-372-2232
Practice Address - Fax:507-372-7326
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7009225100000X
IA03496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1740537OtherARAZ
MN23003OtherSIOUX VALLEY HEALTH PLANS
MN64-03806OtherMEDICA
MN64-03807OtherMEDICA
MNPT7009OtherDAKOTACARE
MN64-04063OtherMEDICA
MN64-05336OtherMEDICA
MN64-04226OtherMEDICA
MN7435OtherAVERA HEALTH PLANS
MN243T9STOtherBLUE CROSS BLUE SHIELD MN