Basic Information
| Provider Information | |||||||||
| NPI: | 1629004031 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPY PARTNERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 MINNEHAHA AVE W STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551041033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517484338 | ||||||||
| FaxNumber: | 6517482892 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 RIVARD ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540257382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152475735 | ||||||||
| FaxNumber: | 7152475738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | MORLEY HENJUM | ||||||||
| AuthorizedOfficialFirstName: | MAGGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6513487432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1629004031 | 05 | WI | MEDICAID | 1407809494 | 05 | MN | MEDICAID |