Organization Name: | PEQUOT LAKES PHYSICAL THERAPY SERVICES, INC |
NPI Number: | 1467589101 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY WULF (OFFICE MANAGER) |
Mailing Address: | 31170 Goverment Dr Pequot Lakes |
State: | MN US |
Postal Code: | 564721001 |
Phone Number: | 2185685666 |
Fax Number: | 2185685466 |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |