Organization Name: | CHILDREN'S THERAPY CTR, INC |
NPI Number: | 1053450742 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN ANN FULLER (OWNER) |
Mailing Address: | 14635 Pennock Ave #300 Apple Valley |
State: | MN US |
Postal Code: | 551246430 |
Phone Number: | 9529972823 |
Fax Number: | 9529976931 |
NPI Enumeration Date: | 02/06/2007 |
NPI Last Update Date: | 11/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |