Individual
BRIAN S REARDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1300 GODWARD ST NE, SUITE 6250, MINNEAPOLIS, MN 55413-1741
(612) 378-0161
Mailing address
3000 LEYLAND VW, WOODBURY, MN 55125-3575
(952) 746-2080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6770
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200P9RE
BLUE CROSS
MN
Enumeration date
11/03/2006
Last updated
07/08/2007
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