Individual
BARRY J PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT CSCS
Contact information
Practice address
1542 GOLF COURSE RD, SUITE 104, GRAND RAPIDS, MN 55744-3555
(218) 326-3300
(218) 326-3400
Mailing address
1542 GOLF COURSE RD, SUITE 104, GRAND RAPIDS, MN 55744-3555
(218) 326-3300
(218) 326-3400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10875-024
WI
225100000X
Physical Therapist
Primary
7925
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36139200
—
WI
Enumeration date
06/27/2007
Last updated
09/05/2008
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