| NPI | 1215986757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SMITH Administrator 952-930-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208D00000X General Practice |
| 111N00000X Chiropractor | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-09-05 |