Provider Demographics
NPI:1700031333
Name:MCNAMARA, THERESA (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ROY ST
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1138
Mailing Address - Country:US
Mailing Address - Phone:320-839-4271
Mailing Address - Fax:
Practice Address - Street 1:611 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-4213
Practice Address - Country:US
Practice Address - Phone:320-523-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist