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NPI Code Detail

MEDICARE: STAY SPRY HEALTH PC

MEDICARE: STAY SPRY HEALTH PC
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
1202D00000XIntegrative Medicine Physician
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3363AM0700XMedical Physician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11215267927OTHERMNINDIVIDUAL NPI

General Provider Information

NPI Number : 1568152312
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAY SPRY HEALTH PC
Provider Business Mailing Address
First Line : 5821 CEDAR LAKE RD S STE 201
Second Line :
City : SAINT LOUIS PARK
State : MN
Zip : 55416-1487
Country : US
Telephone Number : 612-293-0352
Fax Number :
Provider Business Practice Location Address
First Line : 5821 CEDAR LAKE RD S STE 201
Second Line :
City : SAINT LOUIS PARK
State : MN
Zip : 55416-1487
Country : US
Telephone Number : 612-293-0352
Fax Number :
Authorized Official
Title or Position : PHYSICIAN ASSISTANT
Name : KATHERINE SCHROEDER
Credential : PA-C
Telephone Number : 612-963-1223
Provider Enumeration Date : 05/15/2023
Last Update Date : 07/02/2024

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Directions to “STAY SPRY HEALTH PC ” Practice Location

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