Provider Demographics
NPI:1629004692
Name:THEREX REHAB SPECIALISTS, LLC
Entity Type:Organization
Organization Name:THEREX REHAB SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:MARGURITE
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-501-2010
Mailing Address - Street 1:1325 SCHOONER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9295
Mailing Address - Country:US
Mailing Address - Phone:651-501-2010
Mailing Address - Fax:651-730-1121
Practice Address - Street 1:670 COMMERCE DR STE 140
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9290
Practice Address - Country:US
Practice Address - Phone:651-501-2010
Practice Address - Fax:651-436-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN033M9THOtherBCBS OF MN
MN139319700Medicaid