Provider Demographics
NPI:1235310913
Name:NORTHFIELD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NORTHFIELD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CPED
Authorized Official - Phone:507-581-2452
Mailing Address - Street 1:2500 320TH ST W
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4564
Mailing Address - Country:US
Mailing Address - Phone:507-581-2452
Mailing Address - Fax:
Practice Address - Street 1:2500 320TH ST W
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-4564
Practice Address - Country:US
Practice Address - Phone:507-581-2452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty