Healthcare Provider Details

I. General information

NPI: 1295809366
Provider Name (Legal Business Name): CHILDREN'S THERAPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 PILOT KNOB RD STE 100
EAGAN MN
55121-1930
US

IV. Provider business mailing address

2795 PILOT KNOB RD STE 100
EAGAN MN
55121-1930
US

V. Phone/Fax

Practice location:
  • Phone: 651-994-9644
  • Fax:
Mailing address:
  • Phone: 651-994-9644
  • Fax: 651-994-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHERYL HAIBACH
Title or Position: PRACTICE LEADER
Credential:
Phone: 412-585-0313