=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013859305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINEFOCUS PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2026
-----------------------------------------------------
Last Update Date | 04/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 147TH ST W STE 403
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55124-4515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-363-1449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20445 DONNELLY AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55024-9049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MARK DESCHEPPER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 651-363-1449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------