Healthcare Provider Details

I. General information

NPI: 1780987149
Provider Name (Legal Business Name): ON-SITE SOLUTIONS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 HEMLOCK LN N STE B
MAPLE GROVE MN
55369-5646
US

IV. Provider business mailing address

6812 HEMLOCK LN N STE B
MAPLE GROVE MN
55369-5646
US

V. Phone/Fax

Practice location:
  • Phone: 763-657-7547
  • Fax: 763-657-7005
Mailing address:
  • Phone: 763-657-7547
  • Fax: 763-657-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6302
License Number StateMN

VIII. Authorized Official

Name: MELISSA ANN BARROWS GILL
Title or Position: PHYSICAL THERAPIST
Credential: D.P.T.
Phone: 61250147532