Healthcare Provider Details

I. General information

NPI: 1093103145
Provider Name (Legal Business Name): REHABILITATION MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 2ND ST SUITE 204
EXCELSIOR MN
55331-1963
US

IV. Provider business mailing address

464 2ND ST STE 204
EXCELSIOR MN
55331-2015
US

V. Phone/Fax

Practice location:
  • Phone: 612-787-8408
  • Fax:
Mailing address:
  • Phone: 612-787-8408
  • Fax: 612-567-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number48482
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBERT HELTON LONG
Title or Position: OWNER
Credential: M.D.
Phone: 612-787-8408