Individual
MIRANDA JO RISTAU OBANIANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
112 SAINT OLAF AVE S, CANBY, MN 56220-1433
(507) 223-7277
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
(605) 312-9802
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12331
MN
225100000X
Physical Therapist
2321
SD
225100000X
Physical Therapist
—
—
Other
Enumeration date
01/25/2022
Last updated
11/25/2022
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