Provider Demographics
NPI:1528303310
Name:MED-PLUS THERAPY LTD
Entity type:Organization
Organization Name:MED-PLUS THERAPY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:218-233-7029
Mailing Address - Street 1:2901 S FRONTAGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2572
Mailing Address - Country:US
Mailing Address - Phone:218-233-7029
Mailing Address - Fax:218-233-7029
Practice Address - Street 1:2921 S FRONTAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2571
Practice Address - Country:US
Practice Address - Phone:218-233-7029
Practice Address - Fax:218-233-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty