Provider Demographics
NPI:1871037630
Name:MIDWEST PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MIDWEST PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WURM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-886-9607
Mailing Address - Street 1:14440 28TH PL N STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4854
Mailing Address - Country:US
Mailing Address - Phone:612-707-0169
Mailing Address - Fax:612-465-1603
Practice Address - Street 1:14440 28TH PL N STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4854
Practice Address - Country:US
Practice Address - Phone:612-707-0169
Practice Address - Fax:612-465-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy