Provider Demographics
NPI:1174854350
Name:RADTKE PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:RADTKE PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1542 GOLF COURSE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3555
Mailing Address - Country:US
Mailing Address - Phone:218-326-3300
Mailing Address - Fax:218-326-3400
Practice Address - Street 1:1542 GOLF COURSE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3555
Practice Address - Country:US
Practice Address - Phone:218-326-3300
Practice Address - Fax:218-326-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies