Provider Demographics
NPI:1356597546
Name:ENDLESS POSSIBILITIES - INTEGRATIVE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ENDLESS POSSIBILITIES - INTEGRATIVE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:KNAAK
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:612-353-6725
Mailing Address - Street 1:3100 W LAKE ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4527
Mailing Address - Country:US
Mailing Address - Phone:612-353-6725
Mailing Address - Fax:612-353-6728
Practice Address - Street 1:3100 W LAKE ST
Practice Address - Street 2:SUITE 325
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4527
Practice Address - Country:US
Practice Address - Phone:612-353-6725
Practice Address - Fax:612-353-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6427261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1902013634OtherNPI