Provider Demographics
NPI:1356560213
Name:ROOTKIE, TAMI MARIE (LPT)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:MARIE
Last Name:ROOTKIE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1034
Mailing Address - Country:US
Mailing Address - Phone:320-629-0096
Mailing Address - Fax:320-679-8350
Practice Address - Street 1:110 7TH ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1110
Practice Address - Country:US
Practice Address - Phone:320-679-1411
Practice Address - Fax:320-679-8350
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist