Provider Demographics
NPI:1669559191
Name:BOLLINGER, PATRICK ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALLEN
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 30TH AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4769
Mailing Address - Country:US
Mailing Address - Phone:320-763-5505
Mailing Address - Fax:320-763-4447
Practice Address - Street 1:410 30TH AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4769
Practice Address - Country:US
Practice Address - Phone:320-763-5505
Practice Address - Fax:320-763-4447
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004996225100000X
MN7901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03152Medicare PIN