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General NPI Number Information
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NPI Number | 1154144087
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Entity Type | Organization
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Legal Business Name | SKILLED FITNESS & THERAPY LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 170 WILLOW DR W
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City | ANNANDALE
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State | MN
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Zip | 55302-4705
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Country | US
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Telephone | 612-805-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 170 WILLOW DR W
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City | ANNANDALE
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State | MN
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Zip | 55302-4705
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Country | US
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Telephone | 612-805-8833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SPENCER NORMAN HAAG
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Credential | PT, DPT
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Telephone | 612-805-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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