Provider Demographics
NPI:1740887223
Name:THOMAS TARDIF PERFORMANCE SOLUTIONS
Entity type:Organization
Organization Name:THOMAS TARDIF PERFORMANCE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TARDIF
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:612-643-0019
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-0501
Mailing Address - Country:US
Mailing Address - Phone:612-643-0019
Mailing Address - Fax:651-358-2995
Practice Address - Street 1:6702 E SHADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1349
Practice Address - Country:US
Practice Address - Phone:612-643-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty