Provider Demographics
NPI:1083253991
Name:MINNESOTA NEUROREHABILITATION INSTITUTE, PLLC
Entity Type:Organization
Organization Name:MINNESOTA NEUROREHABILITATION INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-850-8278
Mailing Address - Street 1:115 LUCE LINE RDG
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55359-9691
Mailing Address - Country:US
Mailing Address - Phone:612-850-8278
Mailing Address - Fax:
Practice Address - Street 1:12805 HWY 55 STE 304
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3826
Practice Address - Country:US
Practice Address - Phone:612-850-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty