MEDICARE: EARLY INTERVENTION THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1174274252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY INTERVENTION THERAPY LLC

Provider Business Mailing Address
First Line	:	2501 TAYLOR ST NE # 1A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3731
Country	:	US
Telephone Number	:	952-200-4338
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 TAYLOR ST NE # 1A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3731
Country	:	US
Telephone Number	:	952-200-4338
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NUNEY SAID
Credential	:
Telephone Number	:	952-200-4338

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	03/27/2023

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