Healthcare Provider Details

I. General information

NPI: 1083610091
Provider Name (Legal Business Name): RADTKE PHYSICAL THERAPY LTD. PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WILLOW LN
GRAND RAPIDS MN
55744-3938
US

IV. Provider business mailing address

9 WILLOW LN
GRAND RAPIDS MN
55744-3938
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3300
  • Fax: 218-326-3400
Mailing address:
  • Phone: 218-326-3300
  • Fax: 218-326-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL F RADTKE
Title or Position: DIRECTOR/ADMINISTRATOR
Credential: PT
Phone: 218-326-3300