Healthcare Provider Details

I. General information

NPI: 1558472431
Provider Name (Legal Business Name): COMPREHENSIVE REHABILITATION CLINICS OF MN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W LAKE ST
MINNEAPOLIS MN
55408-3119
US

IV. Provider business mailing address

1567 LIBERTY ST
SHAKOPEE MN
55379-4547
US

V. Phone/Fax

Practice location:
  • Phone: 612-823-2020
  • Fax: 612-823-1919
Mailing address:
  • Phone: 952-201-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA TAIJ WATKINS
Title or Position: OWNER
Credential: D.C.
Phone: 952-201-6360