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NPI Code Detail

MEDICARE: EARLY INSIGHT THERAPY LLC

MEDICARE: EARLY INSIGHT 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
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1174328033
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARLY INSIGHT THERAPY LLC
Provider Business Mailing Address
First Line : 8030 OLD CEDAR AVE S STE 100
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-1214
Country : US
Telephone Number : 763-346-0646
Fax Number : 213-867-8282
Provider Business Practice Location Address
First Line : 8030 OLD CEDAR AVE S STE 100
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-1214
Country : US
Telephone Number : 763-346-0646
Fax Number : 213-867-8282
Authorized Official
Title or Position : OWNER/EXECUTIVE DIRECTOR
Name : MUMTAZ HASSAN MOHAMED
Credential :
Telephone Number : 763-346-0646
Provider Enumeration Date : 02/14/2025
Last Update Date : 03/17/2025

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Directions to “EARLY INSIGHT THERAPY LLC ” Practice Location

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