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General NPI Number Information
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NPI Number | 1174089783
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Entity Type | Organization
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Legal Business Name | LITTLE FALLS INTEGRATED PHYSICAL MEDICINE
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 104 2ND ST SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3037
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Country | US
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Telephone | 757-617-8397
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Fax |
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Provider Business Mailing Address
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Address Line | 104 2ND ST SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3037
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Country | US
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Telephone | 757-617-8397
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | PAUL CARPENTER
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Credential | DPT
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Telephone | 320-414-0404
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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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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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