Healthcare Provider Details

I. General information

NPI: 1437011996
Provider Name (Legal Business Name): SELECT THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31170 GOVERNMENT DR
PEQUOT LAKES MN
56472-1001
US

IV. Provider business mailing address

14884 KIRKWOOD DR
BAXTER MN
56425-8451
US

V. Phone/Fax

Practice location:
  • Phone: 218-824-5027
  • Fax: 218-824-8011
Mailing address:
  • Phone: 218-824-5027
  • Fax: 218-824-8011

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: SARA CARLSON
Title or Position: CREDENTIALING SPECIALIST
Credential: MS, OTR/L, CHT
Phone: 218-824-5027