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General NPI Number Information
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NPI Number | 1063659647
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Entity Type | Organization
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Legal Business Name | THE INSTITUTE FOR EXERCISE MEDICINE AND PREVENTION
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 2935 COUNTRY DR SUITE 103
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City | SAINT PAUL
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State | MN
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Zip | 55117-1183
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Country | US
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Telephone | 651-605-2320
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Fax |
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Provider Business Mailing Address
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Address Line | 2935 COUNTRY DR SUITE 103
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City | SAINT PAUL
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State | MN
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Zip | 55117-1183
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Country | US
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Telephone | 651-605-2320
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA LYNN GARR
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Credential | M.D.
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Telephone | 651-605-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 33524
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License Number State | MN
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