Pederson, Barry J

Pederson, Barry J is an individual health care provider with primary practice located at 1542 Golf Course Rd Suite 104, Grand Rapids MN 55744-3555. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Pederson, Barry J can be contacted via phone (218) 326-3300.

Contact Information

Primary practice address
1542 Golf Course Rd Suite 104 Grand Rapids MN 55744-3555
Phone: (218) 326-3300
Fax: (218) 326-3400
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 10875-024 Wisconsin
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 7925 Minnesota

Profile Details

NPI number 1659578417
LBN Legal business name Pederson, Barry J
Credentials DPT CSCS
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2007
Last updated Sep 5th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659578417 NPPES
Wisconsin MEDICAID 36139200

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