=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780987149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON-SITE SOLUTIONS PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2010
-----------------------------------------------------
Last Update Date | 12/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6812 HEMLOCK LN N STE B
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55369-5646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-657-7547
-----------------------------------------------------
Fax | 763-657-7005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6812 HEMLOCK LN N STE B
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55369-5646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-657-7547
-----------------------------------------------------
Fax | 763-657-7005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MELISSA ANN BARROWS GILL
-----------------------------------------------------
Credential | D.P.T.
-----------------------------------------------------
Telephone | 61250147532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 6302
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------