Healthcare Provider Details

I. General information

NPI: 1598914764
Provider Name (Legal Business Name): THERAPY NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SHADY OAK CT
WINONA MN
55987-6034
US

IV. Provider business mailing address

66 SHADY OAK CT
WINONA MN
55987-6034
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-0000
  • Fax: 507-454-6724
Mailing address:
  • Phone: 507-454-0000
  • Fax: 507-454-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2206154
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5191
License Number StateMN

VIII. Authorized Official

Name: ROBERT JOHN SCHRUPP
Title or Position: PHYSICAL THERAPIST/ ADMINISTRATOR
Credential: MA,PT
Phone: 507-454-0000