Provider Demographics
NPI:1750489175
Name:RUOTSINOJA, NICOLE RAE (PTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:RUOTSINOJA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025
Mailing Address - Country:US
Mailing Address - Phone:651-464-1113
Mailing Address - Fax:651-464-0853
Practice Address - Street 1:967 S LAKE ST
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-1113
Practice Address - Fax:651-464-0853
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN282PIGOOtherBCBS
MN246599Medicare ID - Type Unspecified