Provider Demographics
NPI:1003128869
Name:GREAT RIVER THERAPY INC
Entity Type:Organization
Organization Name:GREAT RIVER THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:RAMSEY
Authorized Official - Last Name:GRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-388-7511
Mailing Address - Street 1:416 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2384
Mailing Address - Country:US
Mailing Address - Phone:651-388-7511
Mailing Address - Fax:651-388-2369
Practice Address - Street 1:416 W 3RD ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2384
Practice Address - Country:US
Practice Address - Phone:651-388-7511
Practice Address - Fax:651-388-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty