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General NPI Number Information
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NPI Number | 1770795924
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Entity Type | Organization
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Legal Business Name | MONTICELLO PHYSICAL THERAPY & SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1125 S CEDAR STREET SUITE 103
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City | MONTICELLO
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State | MN
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Zip | 55362
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Country | US
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Telephone | 763-295-4201
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Fax | 763-295-3895
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Provider Business Mailing Address
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Address Line | 307 MAPLE AVE. S PO BOX 834
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City | MAPLE LAKE
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State | MN
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Zip | 55358
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Country | US
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Telephone | 320-963-2023
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Fax | 320-963-2023
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Authorized Official
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Title or Position | PHYSICAL THERAPIST -OWNER
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Name | PAUL WILLIAM STOKMAN
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Credential |
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Telephone | 320-963-2023
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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 | 5232
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License Number State | MN
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