Provider Demographics
NPI:1073582342
Name:QUANTUM PHYSICAL THERAPY & PERSONAL TRNG INC
Entity Type:Organization
Organization Name:QUANTUM PHYSICAL THERAPY & PERSONAL TRNG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:866-280-1051
Mailing Address - Street 1:115 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1223
Mailing Address - Country:US
Mailing Address - Phone:866-280-1051
Mailing Address - Fax:763-201-4689
Practice Address - Street 1:115 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1223
Practice Address - Country:US
Practice Address - Phone:866-280-1051
Practice Address - Fax:763-201-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN293M0QUOtherBCBS
IA19540OtherWELLMARK
IAI11286Medicare ID - Type Unspecified
IA19540OtherWELLMARK