Healthcare Provider Details

I. General information

NPI: 1174089783
Provider Name (Legal Business Name): LITTLE FALLS INTEGRATED PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 2ND ST SE
LITTLE FALLS MN
56345-3037
US

IV. Provider business mailing address

104 2ND ST SE
LITTLE FALLS MN
56345-3037
US

V. Phone/Fax

Practice location:
  • Phone: 757-617-8397
  • Fax:
Mailing address:
  • Phone: 757-617-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL CARPENTER
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 320-414-0404