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General NPI Number Information
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NPI Number | 1174328033
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Entity Type | Organization
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Legal Business Name | EARLY INSIGHT THERAPY LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 8030 OLD CEDAR AVE S STE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1214
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Country | US
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Telephone | 763-346-0646
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Fax | 213-867-8282
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Provider Business Mailing Address
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Address Line | 8030 OLD CEDAR AVE S STE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1214
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Country | US
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Telephone | 763-346-0646
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Fax | 213-867-8282
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MUMTAZ HASSAN MOHAMED
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Credential |
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Telephone | 763-346-0646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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