Provider Demographics
NPI:1760455588
Name:THERAPYWERKS PA
Entity Type:Organization
Organization Name:THERAPYWERKS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HOUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:507-332-2204
Mailing Address - Street 1:1620 17TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-2839
Mailing Address - Country:US
Mailing Address - Phone:507-332-2204
Mailing Address - Fax:507-332-2270
Practice Address - Street 1:1620 17TH ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2839
Practice Address - Country:US
Practice Address - Phone:507-332-2204
Practice Address - Fax:507-332-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN272078700Medicaid
MN8B432THOtherBCBS GROUP NUMBER
MN116113OtherU-CARE GROUP #
MN44229OtherHEALTH PARTNERS GROUP #
MN1012550OtherPREFERRED ONE GROUP #
MN8B432THOtherBCBS GROUP NUMBER