Provider Demographics
NPI:1750631982
Name:PARK AVENUE THERAPIES INC
Entity type:Organization
Organization Name:PARK AVENUE THERAPIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:STEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:763-486-0054
Mailing Address - Street 1:1204 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1622
Mailing Address - Country:US
Mailing Address - Phone:218-878-0805
Mailing Address - Fax:218-879-3599
Practice Address - Street 1:1204 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1622
Practice Address - Country:US
Practice Address - Phone:218-878-0805
Practice Address - Fax:218-879-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9079261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy