Healthcare Provider Details

I. General information

NPI: 1659508182
Provider Name (Legal Business Name): TRUE CARE MEDICAL THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 HIGHWAY 53 SUITE D
COOK MN
55723-5102
US

IV. Provider business mailing address

221 HIGHWAY 53 SUITE D
COOK MN
55723-5102
US

V. Phone/Fax

Practice location:
  • Phone: 218-666-2697
  • Fax:
Mailing address:
  • Phone: 218-666-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5920
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. IDA B. HAXTON
Title or Position: PRESIDENT
Credential: PT
Phone: 218-780-7912