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General NPI Number Information
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NPI Number | 1760455588
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Entity Type | Organization
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Legal Business Name | THERAPYWERKS PA
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1620 17TH ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-2839
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Country | US
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Telephone | 507-332-2204
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Fax | 507-332-2270
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Provider Business Mailing Address
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Address Line | 1620 17TH ST NW
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City | FARIBAULT
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State | MN
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Zip | 55021-2839
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Country | US
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Telephone | 507-332-2204
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Fax | 507-332-2270
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL HOWARD HOUGAN
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Credential | PHYSICAL THERAPIST
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Telephone | 507-332-2204
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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 | 1283
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License Number State | MN
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