Provider Demographics
NPI:1033115084
Name:PHOENIX PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY, INC.
Other - Org Name:SEEDS OF CHANGE HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:952-314-9419
Mailing Address - Street 1:4408 HARRIET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-4851
Mailing Address - Country:US
Mailing Address - Phone:952-314-9419
Mailing Address - Fax:
Practice Address - Street 1:3939 W 69TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2001
Practice Address - Country:US
Practice Address - Phone:952-562-2420
Practice Address - Fax:952-562-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty