Provider Demographics
NPI:1003076613
Name:PROFESSIONAL REHABILITATION CENTER INC
Entity type:Organization
Organization Name:PROFESSIONAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-451-9417
Mailing Address - Street 1:1711 GOLD DR S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6416
Mailing Address - Country:US
Mailing Address - Phone:701-451-9417
Mailing Address - Fax:
Practice Address - Street 1:4420 37TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3400
Practice Address - Country:US
Practice Address - Phone:701-451-9417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty