| NPI | 1013056969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY KOWALKOWSKI Administrator 320-229-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain (Licence: MN 41961) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 41961) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 41961) | |
| 261QP2000X Clinic/Center Physical Therapy (Licence: MN 41961) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-07-14 |