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General NPI Number Information
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NPI Number | 1629373246
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTHCARE AND PHYSICAL MEDICINE PLLC.
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 2151 HAMLINE AVE N STE. 111
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City | ROSEVILLE
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State | MN
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Zip | 55113-4236
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Country | US
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Telephone | 651-636-5560
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Fax | 651-636-4406
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Provider Business Mailing Address
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Address Line | 2151 HAMLINE AVE N STE. 111
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City | ROSEVILLE
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State | MN
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Zip | 55113-4236
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Country | US
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Telephone | 651-636-5560
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Fax | 651-636-4406
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KOULA VANG
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Credential |
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Telephone | 651-636-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 13954
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 30851
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License Number State | MN
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