Individual
NATHAN R DEBRUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
8650 HUDSON BLVD N, SUITE 310, LAKE ELMO, MN 55042-9747
(651) 702-6932
(651) 735-3586
Mailing address
7581 9TH ST N, STE 100, OAKDALE, MN 55128-6635
(651) 748-4338
(651) 748-2892
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6205
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
215K2DE
BLUECROSS BLUESHIELD
MN
05
—
533232000
—
MN
01
—
6404603
MEDICA
MN
01
—
HP42460
HEALTHPARTNERS
MN
Enumeration date
08/25/2006
Last updated
09/09/2019
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