Provider Demographics
NPI:1285706549
Name:PARK RAPIDS PHYSICAL THERAPY AND REHABILITATION CENTER INC
Entity type:Organization
Organization Name:PARK RAPIDS PHYSICAL THERAPY AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-268-6742
Mailing Address - Street 1:200 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1518
Mailing Address - Country:US
Mailing Address - Phone:218-732-0868
Mailing Address - Fax:218-732-8502
Practice Address - Street 1:200 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1518
Practice Address - Country:US
Practice Address - Phone:218-732-0868
Practice Address - Fax:218-732-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN683227000Medicaid
MN246567Medicare ID - Type Unspecified