Provider Demographics
NPI:1598914764
Name:THERAPY NETWORK INC
Entity Type:Organization
Organization Name:THERAPY NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA,PT
Authorized Official - Phone:507-454-0000
Mailing Address - Street 1:66 SHADY OAK CT
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6034
Mailing Address - Country:US
Mailing Address - Phone:507-454-0000
Mailing Address - Fax:507-454-6724
Practice Address - Street 1:66 SHADY OAK CT
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6034
Practice Address - Country:US
Practice Address - Phone:507-454-0000
Practice Address - Fax:507-454-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5191235Z00000X
WI2206154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1760607840Medicaid