Individual
PRENTICE VALVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
708 MOUND AVE, MANKATO, MN 56001-1645
(507) 385-4300
Mailing address
708 MOUND AVE, MANKATO, MN 56001-1645
(507) 385-4300
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
A1546
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A1546
BOARD OF PHYSICAL THERAPY
MN
Enumeration date
04/29/2019
Last updated
06/11/2019
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