Provider Demographics
NPI:1770238396
Name:MINNESOTA ORTHOPEDIC PERFORMANCE AND PREVENTION LLC
Entity Type:Organization
Organization Name:MINNESOTA ORTHOPEDIC PERFORMANCE AND PREVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-305-4313
Mailing Address - Street 1:2721 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1105
Mailing Address - Country:US
Mailing Address - Phone:651-412-3072
Mailing Address - Fax:
Practice Address - Street 1:2721 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1105
Practice Address - Country:US
Practice Address - Phone:651-412-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty