Provider Demographics
NPI:1194097337
Name:THE AMAZING JOURNEY, LLC
Entity type:Organization
Organization Name:THE AMAZING JOURNEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-454-4600
Mailing Address - Street 1:7658 DESIGN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8439
Mailing Address - Country:US
Mailing Address - Phone:218-454-4600
Mailing Address - Fax:218-454-4601
Practice Address - Street 1:7658 DESIGN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8439
Practice Address - Country:US
Practice Address - Phone:218-454-4600
Practice Address - Fax:218-454-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86452251P0200X
MN104320225X00000X
MN8993235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty