# SPORTS ORTHOPEDIC ADVANCED REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780910802
- **Authorized official:** DR. TERESA L. GURIN M.D. (PRESIDENT)
- **Authorized official phone:** (952) 223-3339

## Contact information

- **Practice address:** 4660 SLATER RD STE 240, EAGAN, MN 55122
- **Practice address phone:** (952) 223-3339
- **Practice address fax:** (952) 314-1401
- **Mailing address:** 4660 SLATER RD STE 240, EAGAN, MN 55122-4047
- **Mailing address phone:** (952) 223-3339
- **Mailing address fax:** (952) 314-1401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 39052 | MN | Yes |

## Other

- **Enumeration date:** 10/23/2009
- **Last updated:** 11/07/2019