MEDICARE: PERSIST THERAPY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174125819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSIST THERAPY

Provider Business Mailing Address
First Line	:	46537 EVERGREEN LN
Second Line	:
City	:	CLEVELAND
State	:	MN
Zip	:	56017-4528
Country	:	US
Telephone Number	:	507-338-6446
Fax Number	:

Provider Business Practice Location Address
First Line	:	46537 EVERGREEN LN
Second Line	:
City	:	CLEVELAND
State	:	MN
Zip	:	56017-4528
Country	:	US
Telephone Number	:	507-338-6446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMANTHA OLSEN
Credential	:	OTD, OTR/L
Telephone Number	:	507-338-6446

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/09/2020

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Directions to “PERSIST THERAPY ” Practice Location

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