Healthcare Provider Details

I. General information

NPI: 1104416957
Provider Name (Legal Business Name): EMPOWER YOU PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4082 FLAG AVE N
NEW HOPE MN
55427-1040
US

IV. Provider business mailing address

4082 FLAG AVE N
NEW HOPE MN
55427-1040
US

V. Phone/Fax

Practice location:
  • Phone: 319-329-2711
  • Fax:
Mailing address:
  • Phone: 319-329-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACEY LEACH
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT, MHA, MSCS
Phone: 319-329-2711