Provider Demographics
NPI:1346533577
Name:ADVANCED ARM DYNAMICS OF MINNESOTA
Entity Type:Organization
Organization Name:ADVANCED ARM DYNAMICS OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIGUELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:310-372-3050
Mailing Address - Street 1:123 W TORRANCE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3610
Mailing Address - Country:US
Mailing Address - Phone:310-372-3050
Mailing Address - Fax:310-372-3057
Practice Address - Street 1:11671 FOUNTAINS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4711
Practice Address - Country:US
Practice Address - Phone:763-420-2767
Practice Address - Fax:763-322-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty