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General NPI Number Information
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NPI Number | 1487240693
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Entity Type | Organization
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Legal Business Name | PRESCOTT THERAPIES LLC
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 825 NICOLLET MALL STE 1947
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2707
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Country | US
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Telephone | 952-200-0215
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Fax | 833-499-1896
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Provider Business Mailing Address
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Address Line | 18872 42ND AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3068
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Country | US
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Telephone | 952-807-7312
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TRAVIS JOHN KIERSTEAD
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Credential | PT
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Telephone | 952-807-7312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational 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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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