Provider Demographics
NPI:1346287158
Name:MULTICENTER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MULTICENTER PHYSICAL THERAPY, LLC
Other - Org Name:SANTEMA AND ASSOCIATES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANTEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-767-3140
Mailing Address - Street 1:7700 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2832
Mailing Address - Country:US
Mailing Address - Phone:763-784-3155
Mailing Address - Fax:763-784-2352
Practice Address - Street 1:7700 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2832
Practice Address - Country:US
Practice Address - Phone:763-784-3155
Practice Address - Fax:763-784-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9113142-00Medicaid
MNDA0396OtherMC RAILROAD GROUP NUMBER
MNDA0396OtherMC RAILROAD GROUP NUMBER