MEDICARE: TOTAL CONNECTION PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8414	MN

General Provider Information

NPI Number	:	1013341353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CONNECTION PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	388 CLEVELAND AVE SW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-3553
Country	:	US
Telephone Number	:	218-341-1531
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 CLEVELAND AVE SW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-3553
Country	:	US
Telephone Number	:	218-341-1531
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MARIANE LYN WALIN
Credential	:	PT, DPT, CIMT
Telephone Number	:	218-341-1531

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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