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Ambulatory Health Care Facilities Clinic/Center Physical Therapy

Provider NPI: 1467403030

Organization Information:
Organization is not Subpart
Authorized Official:  RICHARD VINCENT OTTOMEYER  CEO OWNER  651-464-1113

Practice Location:
Tel: 651-464-1113  Fax: 651-464-0853

Business Mailing Address:
967 LAKE ST S  FOREST LAKE, MN 55025-2616 US
Tel: 651-464-1113  Fax: 651-464-0853

NPI Information:
NPI: 1467403030
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N261QP2000XAmbulatory Health Care Facilities
Physical Therapy
Y261QM1300XAmbulatory Health Care Facilities

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QM1300X





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