Provider Demographics
NPI:1750903175
Name:MOBILE PT MN, LLC
Entity type:Organization
Organization Name:MOBILE PT MN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:763-639-5237
Mailing Address - Street 1:15473 SANDHILL CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1419
Mailing Address - Country:US
Mailing Address - Phone:763-639-5237
Mailing Address - Fax:
Practice Address - Street 1:8725 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5800
Practice Address - Country:US
Practice Address - Phone:763-639-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty