Provider Demographics
NPI:1902668692
Name:FRIESE, RAELIN MCKAE
Entity Type:Individual
Prefix:
First Name:RAELIN
Middle Name:MCKAE
Last Name:FRIESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAELIN
Other - Middle Name:MCKAE
Other - Last Name:ENSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1610
Mailing Address - Country:US
Mailing Address - Phone:320-226-8403
Mailing Address - Fax:
Practice Address - Street 1:122 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1610
Practice Address - Country:US
Practice Address - Phone:320-981-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant