Provider Demographics
NPI:1063786689
Name:RIVER RESTORATIVE THERAPIES LLC
Entity type:Organization
Organization Name:RIVER RESTORATIVE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTUREST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:NORDBY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:763-248-3358
Mailing Address - Street 1:14166 QUINCE ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4137
Mailing Address - Country:US
Mailing Address - Phone:763-248-3358
Mailing Address - Fax:
Practice Address - Street 1:14166 QUINCE ST NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4137
Practice Address - Country:US
Practice Address - Phone:763-248-3358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation