| Optimal Sports Physical Therapy,llc | |
|
1400 1st St Ne, New Prague, MN 56071-2215 | |
| (952) 758-2535 | |
| Not Available |
| Full Name | Optimal Sports Physical Therapy,llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 1400 1st St Ne, New Prague, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932209020 | NPI | - | NPPES |
| 14N26OP | Other | MN | MN BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 5990 (Minnesota) | Primary |
| 225100000X | Physical Therapist | 6759 (Minnesota) | Secondary |
| Provider Name | Paul A Berg |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699875757 PECOS PAC ID: 4183625585 Enrollment ID: I20070129000185 |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Sports Physical Therapy,llc 801 Heritage Trl, New Prague, MN 56071-2200 Ph: () - | Optimal Sports Physical Therapy,llc 1400 1st St Ne, New Prague, MN 56071-2215 Ph: (952) 758-2535 |
Luke Jon Tietz, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 504 6th Ave Nw, New Prague, MN 56071 Phone: 952-257-8800 | |
Colleen Ambroz, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-758-4431 | |
John Conrad Masberg, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-758-4431 | |
Stephanie Nicole Gill, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-257-8800 | |
Dr. Peter Paul Ly, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 504 6th Ave Nw, New Prague, MN 56071 Phone: 952-257-8800 | |
Colleen Marie Turner, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-257-8997 | |
Heidi Bell, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 301 2nd St Ne, New Prague, MN 56071 Phone: 952-257-8800 |