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General NPI Number Information
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NPI Number | 1437127834
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Entity Type | Organization
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Legal Business Name | PARK AVENUE THERAPIES
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 1204 CLOQUET AVE
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City | CLOQUET
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State | MN
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Zip | 55720-1622
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Country | US
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Telephone | 218-878-0805
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Fax | 218-878-0794
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Provider Business Mailing Address
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Address Line | 1204 CLOQUET AVE PO BOX 407
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City | CLOQUET
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State | MN
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Zip | 55720-1622
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Country | US
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Telephone | 218-878-0805
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Fax | 218-878-0794
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Authorized Official
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Title or Position | OWNER
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Name | RHONDA J. JOHNSON
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Credential | P.T.
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Telephone | 218-878-0805
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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 | 4406
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License Number State | MN
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