| NPI | 1811313612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN JAY DETTMER Owner 218-999-5554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MN 7152) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-06-26 |