Provider Demographics
NPI:1780162552
Name:PRESENCE TELEHEALTH PLLC
Entity type:Organization
Organization Name:PRESENCE TELEHEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COOPER
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:805-698-8480
Mailing Address - Street 1:5507 CHATEAU RD NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0136
Mailing Address - Country:US
Mailing Address - Phone:805-698-8480
Mailing Address - Fax:
Practice Address - Street 1:5507 CHATEAU RD NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0136
Practice Address - Country:US
Practice Address - Phone:651-508-0936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty