MEDICARE: QUANTUM PHYSICAL THERAPY & PERSONAL TRNG INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	293M0QU	OTHER	MN	BCBS
2	19540	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1073582342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM PHYSICAL THERAPY & PERSONAL TRNG INC

Provider Business Mailing Address
First Line	:	115 N BROADWAY
Second Line	:
City	:	SPRING VALLEY
State	:	MN
Zip	:	55975-1223
Country	:	US
Telephone Number	:	866-280-1051
Fax Number	:	763-201-4689

Provider Business Practice Location Address
First Line	:	115 N BROADWAY
Second Line	:
City	:	SPRING VALLEY
State	:	MN
Zip	:	55975-1223
Country	:	US
Telephone Number	:	866-280-1051
Fax Number	:	763-201-4689

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHERI ANN MCGEE
Credential	:	PT
Telephone Number	:	866-280-1051

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/21/2007

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