# MINNESOTA MEDICAL AND REHABILITATIVE SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Minnesota Medical and Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154302545
- **Authorized official:** JACOB I MIRMAN MD (MANAGING PARTNER)
- **Authorized official phone:** (952) 933-8900

## Contact information

- **Practice address:** 4201 EXCELSIOR BLVD, ST. LOUIS PARK, MN 55416-4728
- **Practice address phone:** (952) 564-3880
- **Practice address fax:** (952) 945-9536
- **Mailing address:** 4201 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-4728
- **Mailing address phone:** (952) 933-8900
- **Mailing address fax:** (952) 945-9536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 1544 | MN | Yes |
| 225100000X | Physical Therapist | 2264 | MN | — |
| 225100000X | Physical Therapist | 5806 | MN | — |
| 225X00000X | Occupational Therapist | 102980 | MN | — |
| 235Z00000X | Speech-Language Pathologist | 5169 | MN | — |
| 235Z00000X | Speech-Language Pathologist | 6034 | MN | — |

## Other

- **Enumeration date:** 11/11/2005
- **Last updated:** 09/18/2025