Provider Demographics
NPI:1437451853
Name:PERHAM PHYSICAL THERAPY LTD.
Entity Type:Organization
Organization Name:PERHAM PHYSICAL THERAPY LTD.
Other - Org Name:ORTHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-248-4667
Mailing Address - Street 1:11995 SINGLETREE LANE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-491-4442
Mailing Address - Fax:888-990-0480
Practice Address - Street 1:11995 SINGLETREE LANE
Practice Address - Street 2:SUITE 120
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-491-4442
Practice Address - Fax:888-990-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN136635100Medicaid
MN650000359Medicare PIN