Provider Demographics
NPI:1366460719
Name:PHYSICAL THERAPY CONSULTANTS, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CONSULTANTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ROCKSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-269-8052
Mailing Address - Street 1:139 MAIN STREET
Mailing Address - Street 2:P. O. BOX 136
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005
Mailing Address - Country:US
Mailing Address - Phone:763-269-8051
Mailing Address - Fax:763-269-8053
Practice Address - Street 1:16210 ABERDEEN ST NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-5410
Practice Address - Country:US
Practice Address - Phone:763-413-0880
Practice Address - Fax:763-413-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6409001OtherMEDICA
MN633017700Medicaid
MN04T13NEOtherBLUE CROSS
=========Medicare UPIN
MN633017700Medicaid