Provider Demographics
NPI:1639710478
Name:BATTAGLIA, THOMAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BATTAGLIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23212 SAINT FRANCIS BLVD NW
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-2300
Practice Address - Country:US
Practice Address - Phone:763-753-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic