Healthcare Provider Details

I. General information

NPI: 1740797893
Provider Name (Legal Business Name): OWATONNA SPORTS AND PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S OAK AVE STE 2
OWATONNA MN
55060-3957
US

IV. Provider business mailing address

1414 S OAK AVE STE 2
OWATONNA MN
55060-3957
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-8254
  • Fax:
Mailing address:
  • Phone: 507-451-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SACHS
Title or Position: OFFICE MANAGER
Credential:
Phone: 507-451-8254