MEDICARE: MAGNITUDE THERAPY SERVICES 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1609618925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNITUDE THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	6520 EDENVALE BLVD STE 112
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-2564
Country	:	US
Telephone Number	:	612-261-9312
Fax Number	:	612-500-4700

Provider Business Practice Location Address
First Line	:	6520 EDENVALE BLVD STE 112
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-2564
Country	:	US
Telephone Number	:	612-261-9312
Fax Number	:	612-500-4700

Authorized Official
Title or Position	:	CEO
Name	:	ABDIRIZAK ALI ISMAIL
Credential	:
Telephone Number	:	612-261-9312

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	03/26/2025

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