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General NPI Number Information
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NPI Number | 1023070554
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Entity Type | Organization
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Legal Business Name | PHYSICAL AND OCCUPATIONAL MEDICINE ASSOCIATES, PA
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Dates
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Enumeration Date | 04/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3601 PARK CENTER BLVD SUITE 311
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2531
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Country | US
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Telephone | 952-922-2012
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Fax | 952-922-2013
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Provider Business Mailing Address
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Address Line | 3601 PARK CENTER BLVD SUITE 311
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2531
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Country | US
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Telephone | 952-922-2012
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Fax | 952-922-2913
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN GALIN SANDNESS
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Credential | MD
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Telephone | 952-922-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 28205
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License Number State | MN
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