Organization Name: | PARK NICOLLET |
NPI Number: | 1053623785 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID ABELSON (PRESIDENT/CEO) |
Mailing Address: | 8455 Flying Cloud Dr Eden Prairie |
State: | MN US |
Postal Code: | 553443974 |
Phone Number: | 9529937470 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2010 |
NPI Last Update Date: | 07/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 8510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |