Individual
COOPER VAUGHN TIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13278
MN
Other
Enumeration date
08/29/2023
Last updated
09/05/2024
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