Organization Name: | PHENOM PHYSICAL THERAPY |
NPI Number: | 1902255383 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG L BUTTURFF (OWNER) |
Mailing Address: | 703 Thielen Dr Saint Michael |
State: | MN US |
Postal Code: | 553769613 |
Phone Number: | 7634971153 |
Fax Number: | 7634975256 |
NPI Enumeration Date: | 06/07/2016 |
NPI Last Update Date: | 06/07/2016 |
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: |