Healthcare Provider Details

I. General information

NPI: 1821547266
Provider Name (Legal Business Name): HORIZON PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 28TH ST
MINNEAPOLIS MN
55406-2990
US

IV. Provider business mailing address

2700 E 28TH ST
MINNEAPOLIS MN
55406-2990
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-7769
  • Fax: 612-367-4285
Mailing address:
  • Phone: 612-345-7769
  • Fax: 612-367-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0849
License Number StateMN

VIII. Authorized Official

Name: HASSAN ALLY RAGE
Title or Position: DIRECTOR
Credential:
Phone: 612-345-7769