Provider Demographics
NPI:1467570226
Name:ST MICHAEL SPINAL REHAB CENTER INC
Entity Type:Organization
Organization Name:ST MICHAEL SPINAL REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-497-2787
Mailing Address - Street 1:400 CENTRAL AVE E STE 70
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE E STE 70
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9525
Practice Address - Country:US
Practice Address - Phone:763-497-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7B663MIOtherBLUE CROSS
24-6594Medicare ID - Type Unspecified