| NPI | 1922450394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI LARSON Physical Therapist/CEO 320-979-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: SD 1151) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: SD 1151) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2017-04-18 |