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Organization
SUPREME PHYSICAL THERAPY, INC.
Active
Organization
SUPREME PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MARY PRIEM PHYSICAL THERAPIST (OWNER)
(612) 805-2741
Entity
Organization
Contact information
Practice address
5201 CHOWEN AVE S, MINNEAPOLIS, MN 55410-2121
(612) 805-2741
Mailing address
5201 CHOWEN AVE S, MINNEAPOLIS, MN 55410-2121
(612) 805-2741
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4097
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
349G0SU
BLUE CROSS/BLUE SHIELD
MN
Enumeration date
02/06/2006
Last updated
08/22/2020
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