Organization
INTERVENTIONAL PAIN & PHYSICAL MEDICINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY KOWALKOWSKI RN (ADMINISTRATOR)
(320) 229-1500
Entity
Organization
Contact information
Practice address
2301 CONNECTICUT AVE S, SARTELL, MN 56377-2474
(320) 229-1500
(320) 229-1505
Mailing address
2301 CONNECTICUT AVE S, SARTELL, MN 56377-2474
(320) 229-1500
(320) 229-1505
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
10/05/2012
Last updated
10/05/2012
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