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General NPI Number Information
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NPI Number | 1902096167
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Entity Type | Organization
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Legal Business Name | PRIME REHABILITATION LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 8690 EAGLE CREEK PKWY
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City | SAVAGE
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State | MN
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Zip | 55378-1284
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Country | US
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Telephone | 952-412-6207
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Fax | 952-487-2829
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Provider Business Mailing Address
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Address Line | 8690 EAGLE CREEK PKWY
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City | SAVAGE
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State | MN
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Zip | 55378-1284
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Country | US
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Telephone | 952-412-6207
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Fax | 952-487-2829
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LEONARD KALLBERG
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Credential | PT
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Telephone | 952-412-6207
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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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