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General NPI Number Information
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NPI Number | 1477682110
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Entity Type | Organization
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Legal Business Name | PHOENIX PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 3200 CORPORATE CENTER DR STE 113
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City | BURNSVILLE
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State | MN
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Zip | 55306-5540
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Country | US
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Telephone | 952-808-2222
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Fax | 952-808-2200
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Provider Business Mailing Address
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Address Line | 3200 CORPORATE CENTER DR STE 113
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City | BURNSVILLE
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State | MN
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Zip | 55306-5540
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Country | US
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Telephone | 952-808-2222
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Fax | 952-808-2200
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Authorized Official
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Title or Position | PRESIDENT
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Name | DORI C BROWN
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Credential | PT
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Telephone | 952-808-2222
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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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