Provider Demographics
NPI:1891250635
Name:PHYSIYO, LLC
Entity Type:Organization
Organization Name:PHYSIYO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:952-234-0377
Mailing Address - Street 1:21581 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8162
Mailing Address - Country:US
Mailing Address - Phone:651-249-8070
Mailing Address - Fax:
Practice Address - Street 1:8646 EAGLE CREEK CIR SUITE 109
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1572
Practice Address - Country:US
Practice Address - Phone:952-234-0377
Practice Address - Fax:612-324-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy