Provider Demographics
NPI: | 1164197539 |
---|---|
Name: | TRIA ORTHOPAEDIC CENTER LLC |
Entity Type: | Organization |
Organization Name: | TRIA ORTHOPAEDIC CENTER LLC |
Other - Org Name: | TRIA NECK AND BACK STRENGTHENING PROGRAM |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | LUHRS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 952-883-7158 |
Mailing Address - Street 1: | 8100 NORTHLAND DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BLOOMINGTON |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55431-4800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-831-8742 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8100 NORTHLAND DR |
Practice Address - Street 2: | |
Practice Address - City: | BLOOMINGTON |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55431-4800 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-831-8742 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-08-09 |
Last Update Date: | 2021-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty |