Provider Demographics
NPI:1891200655
Name:ACCESS GROUP PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ACCESS GROUP PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NILS
Authorized Official - Last Name:BRUSTUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-330-2286
Mailing Address - Street 1:2800 RICE ST STE 159
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2277
Mailing Address - Country:US
Mailing Address - Phone:651-330-2286
Mailing Address - Fax:651-340-1988
Practice Address - Street 1:2800 RICE ST STE 159
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55113-2277
Practice Address - Country:US
Practice Address - Phone:651-249-6805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-02
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty