Provider Demographics
NPI:1508135682
Name:RAAK, ANDREW ARTHUR (CMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ARTHUR
Last Name:RAAK
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 CEDAR LAKE RD S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1472
Mailing Address - Country:US
Mailing Address - Phone:612-229-0236
Mailing Address - Fax:
Practice Address - Street 1:5871 CEDAR LAKE RD S
Practice Address - Street 2:SUITE 212
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1472
Practice Address - Country:US
Practice Address - Phone:612-229-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MN1653171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist