Individual ProviderTegan OttoPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address15301 Grove Cir N, Maple Grove, MN 55369-4475(952) 993-5900PECOS EnrollmentBased on the most recent information from CMS, provider Tegan Otto does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1740639889Provider TypeIndividualFull NameOtto, TeganCredentialPT, DPTGenderFemaleSole ProprietorNoEnumeration Date6/9/2016Last Updated3/9/2021Contact InformationPractice LocationPractice Address15301 Grove Cir N, Maple Grove, MN 55369-4475Phone(952) 993-5900FaxUnlisted FaxMailing LocationMailing Address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense10264Minnesota