=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356597546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDLESS POSSIBILITIES - INTEGRATIVE PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2008
-----------------------------------------------------
Last Update Date | 08/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 W LAKE ST SUITE 325
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-353-6725
-----------------------------------------------------
Fax | 612-353-6728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 W LAKE ST SUITE 325
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-353-6725
-----------------------------------------------------
Fax | 612-353-6728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PT
-----------------------------------------------------
Name | NAOMI KNAAK KIMBALL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 612-353-6725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 6427
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------