Provider Demographics
NPI:1669675682
Name:ORTHOREHAB SPECIALISTS, INC
Entity Type:Organization
Organization Name:ORTHOREHAB SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIEWERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:612-339-2041
Mailing Address - Street 1:800 PRAIRIE CENTER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7328
Mailing Address - Country:US
Mailing Address - Phone:952-746-5858
Mailing Address - Fax:952-746-5859
Practice Address - Street 1:800 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7328
Practice Address - Country:US
Practice Address - Phone:952-746-5858
Practice Address - Fax:952-746-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8B813OROtherBC GROUP PROV #
MN8B813OROtherBC GROUP PROV #