Healthcare Provider Details

I. General information

NPI: 1750584777
Provider Name (Legal Business Name): ORTHOREHAB SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S SUITE 260
EDINA MN
55435-1805
US

IV. Provider business mailing address

6600 FRANCE AVE S SUITE 260
EDINA MN
55435-1805
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-0330
  • Fax: 952-922-0990
Mailing address:
  • Phone: 612-339-2041
  • Fax: 612-339-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name: MARK W SIEWERT
Title or Position: OWNER
Credential: PT
Phone: 612-339-2041