Healthcare Provider Details

I. General information

NPI: 1861495582
Provider Name (Legal Business Name): OWATONNA PHYSICAL THERAPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/22/2020
Certification Date:
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: 507-451-7324
Mailing address:
  • Phone: 507-451-8254
  • Fax: 507-451-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6296
License Number StateMN

VIII. Authorized Official

Name: MRS. MARY ELLEN PETERSON
Title or Position: OWNER
Credential:
Phone: 507-451-8254