| Park Avenue Therapies | |
|
1204 Cloquet Ave, Cloquet, MN 55720-1622 | |
| (218) 878-0805 | |
| (218) 878-0794 |
| Full Name | Park Avenue Therapies |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 1204 Cloquet Ave, Cloquet, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437127834 | NPI | - | NPPES |
| 806518700 | Medicaid | MN | |
| DC4813 | Other | MEDICARE RAILROAD | |
| N010204 | Other | MN | TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 4406 (Minnesota) | Primary |
| Provider Name | Joseph Urban Quade |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134168404 PECOS PAC ID: 3072538784 Enrollment ID: I20051012000268 |
| Provider Name | Rhonda Jean Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861452724 PECOS PAC ID: 6204817406 Enrollment ID: I20101023000191 |
| Provider Name | Kathryn D Roufs |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326352535 PECOS PAC ID: 1850587387 Enrollment ID: I20101123001034 |
| Provider Name | Cory Wheeler Gebhard |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912416173 PECOS PAC ID: 9436425592 Enrollment ID: I20171018001171 |
| Provider Name | Megan L Nelson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669025979 PECOS PAC ID: 3971832445 Enrollment ID: I20190909001787 |
| Provider Name | Amanda Marie Dornhecker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245907195 PECOS PAC ID: 8921406612 Enrollment ID: I20211011001782 |
| Mailing Address | Practice Location Address |
|---|---|
| Park Avenue Therapies 1204 Cloquet Ave, Po Box 407, Cloquet, MN 55720-1622 Ph: (218) 878-0805 | Park Avenue Therapies 1204 Cloquet Ave, Cloquet, MN 55720-1622 Ph: (218) 878-0805 |
Joseph Urban Quade, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1204 Cloquet Ave, Cloquet, MN 55720 Phone: 218-878-0805 Fax: 218-878-0794 | |
Stephanie Ann Elling, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1204 Cloquet Ave, Cloquet, MN 55720 Phone: 218-878-0805 Fax: 218-878-0794 | |
Amanda Marie Dornhecker, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 927 Trettel Ln, Cloquet, MN 55720 Phone: 218-879-1227 | |
Danielle Prom, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 701 Horizon Cir, Cloquet, MN 55720 Phone: 218-879-6956 | |
Kathryn Dorothy Roufs, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1204 Cloquet Ave, Cloquet, MN 55720 Phone: 218-878-0805 | |
Kelly Lynn Burgner, DPT Physical Therapist Medicare: May Accept Medicare Assignments Practice Location: 1204 Cloquet Ave, Cloquet, MN 55720 Phone: 218-878-0805 |