Provider Demographics
NPI:1174650519
Name:ADVANCE MOTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCE MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:763-503-1122
Mailing Address - Street 1:6800 78TH AVENUE NORTH
Mailing Address - Street 2:STE 110
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445
Mailing Address - Country:US
Mailing Address - Phone:763-503-1122
Mailing Address - Fax:763-503-1127
Practice Address - Street 1:6800 78TH AVENUE NORTH
Practice Address - Street 2:STE 110
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:763-503-1122
Practice Address - Fax:763-503-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7018261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy