Provider Demographics
NPI:1558472431
Name:COMPREHENSIVE REHABILITATION CLINICS OF MN, P.A.
Entity Type:Organization
Organization Name:COMPREHENSIVE REHABILITATION CLINICS OF MN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TAIJ
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-201-6360
Mailing Address - Street 1:1567 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4547
Mailing Address - Country:US
Mailing Address - Phone:952-201-6360
Mailing Address - Fax:
Practice Address - Street 1:133 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3119
Practice Address - Country:US
Practice Address - Phone:612-823-2020
Practice Address - Fax:612-823-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center