Healthcare Provider Details

I. General information

NPI: 1346287158
Provider Name (Legal Business Name): MULTICENTER PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 HIGHWAY 65 NE
SPRING LAKE PARK MN
55432-2832
US

IV. Provider business mailing address

7700 HIGHWAY 65 NE
SPRING LAKE PARK MN
55432-2832
US

V. Phone/Fax

Practice location:
  • Phone: 763-784-3155
  • Fax: 763-784-2352
Mailing address:
  • Phone: 763-784-3155
  • Fax: 763-784-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9113142-00
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 2
IdentifierDA0396
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMC RAILROAD GROUP NUMBER

VIII. Authorized Official

Name: MS. SUSAN ANN SANTEMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 763-767-3140