| NPI | 1780059949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON KENT BANKS Owner 507-513-1370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MN 5586) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MN A523) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |