Provider Demographics
NPI:1659508182
Name:TRUE CARE MEDICAL THERAPY CENTER INC
Entity Type:Organization
Organization Name:TRUE CARE MEDICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:218-780-7912
Mailing Address - Street 1:221 HIGHWAY 53
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723-5102
Mailing Address - Country:US
Mailing Address - Phone:218-666-2697
Mailing Address - Fax:
Practice Address - Street 1:221 HIGHWAY 53
Practice Address - Street 2:SUITE D
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723-5102
Practice Address - Country:US
Practice Address - Phone:218-666-2697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5920225100000X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty