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General NPI Number Information
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NPI Number | 1841888054
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Entity Type | Organization
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Legal Business Name | PROSPER PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 168 LAKE ST S STE C
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City | FOREST LAKE
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State | MN
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Zip | 55025-2676
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Country | US
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Telephone | 612-718-2669
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Fax |
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Provider Business Mailing Address
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Address Line | 20810 ODELL CT N
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City | SCANDIA
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State | MN
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Zip | 55073-6400
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Country | US
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Telephone | 651-538-0590
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Fax | 651-927-0450
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY MARIE GOEHNER
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Credential | PT
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Telephone | 651-538-0590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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