| NPI | 1124540968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LANHAM Director 952-835-4512 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2020-06-01 |