Individual
GRAYSON TYLER STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2270 FORD PKWY STE 200, SAINT PAUL, MN 55116-3412
(612) 672-7100
Mailing address
24451 INWOOD AVE N, FOREST LAKE, MN 55025-8375
(651) 325-7463
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13531
MN
Other
Enumeration date
06/12/2024
Last updated
06/20/2024
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