| Organization Name: | INTERVENTIONAL PAIN & PHYSICAL MEDICINE CLINIC |
| NPI Number: | 1013056969 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACY KOWALKOWSKI (ADMINISTRATOR) |
| Mailing Address: | 2301 Connecticut Avenue South Sartell |
| State: | MN US |
| Postal Code: | 563772474 |
| Phone Number: | 3202291500 |
| Fax Number: | 3202291505 |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 07/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 41961 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |