MEDICARE: MOBILE PT MN, 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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1750903175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE PT MN, LLC

Provider Business Mailing Address
First Line	:	15473 SANDHILL CIR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1419
Country	:	US
Telephone Number	:	763-639-5237
Fax Number	:

Provider Business Practice Location Address
First Line	:	8725 COLUMBINE RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5800
Country	:	US
Telephone Number	:	763-639-5237
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, OWNER
Name	:	KEVIN ENGLUND
Credential	:	DPT
Telephone Number	:	763-639-5237

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/27/2020

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