Provider Demographics
NPI:1003075938
Name:MCRAE, TINA (CMT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E HENNEPIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1006
Mailing Address - Country:US
Mailing Address - Phone:612-251-2111
Mailing Address - Fax:612-379-5353
Practice Address - Street 1:416 E HENNEPIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1006
Practice Address - Country:US
Practice Address - Phone:612-251-2111
Practice Address - Fax:612-379-5353
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist