# MONTICELLO PHYSICAL THERAPY & SPORTS MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Monticello Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770795924
- **Authorized official:** PAUL WILLIAM STOKMAN (PHYSICAL THERAPIST -OWNER)
- **Authorized official phone:** (320) 963-2023

## Contact information

- **Practice address:** 1125 S CEDAR STREET SUITE 103, MONTICELLO, MN 55362
- **Practice address phone:** (763) 295-4201
- **Practice address fax:** (763) 295-3895
- **Mailing address:** 307 MAPLE AVE. S, PO BOX 834, MAPLE LAKE, MN 55358
- **Mailing address phone:** (320) 963-2023
- **Mailing address fax:** (320) 963-2023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 5232 | MN | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020