Healthcare Provider's Profile
Full Name | |
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Type | Facility |
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Speciality | Clinic/center - Rehabilitation |
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Location | 13810 Shepherds Path Nw, Prior Lake, Minnesota |
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Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
NPI Data:
- NPI Number: 1134818610
- Provider Enumeration Date: 05/02/2023
- Last Update Date: 08/04/2023
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1134818610 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
2845 Hamline Ave N, Roseville, MN 55113-7127 Ph: (651) 631-6415 | 13810 Shepherds Path Nw, Prior Lake, MN 55379-2455 Ph: (651) 631-6570 |
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