MEDICARE: DAWN THERAPY INC

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	:	1437758042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN THERAPY INC

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S STE 106
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2489
Country	:	US
Telephone Number	:	612-532-6627
Fax Number	:	612-886-2618

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 106
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2489
Country	:	US
Telephone Number	:	612-532-6627
Fax Number	:	612-886-2618

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ABDULLAHI SIYAD SR.
Credential	:
Telephone Number	:	612-532-6627

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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Directions to “DAWN THERAPY INC ” Practice Location

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