Provider Demographics
NPI:1093103145
Name:REHABILITATION MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HELTON
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-787-8408
Mailing Address - Street 1:464 2ND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1963
Mailing Address - Country:US
Mailing Address - Phone:612-787-8408
Mailing Address - Fax:
Practice Address - Street 1:464 2ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1963
Practice Address - Country:US
Practice Address - Phone:612-787-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty