Organization
PARK AVENUE THERAPIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA J. JOHNSON P.T. (OWNER)
(218) 878-0805
Entity
Organization
Contact information
Practice address
1204 CLOQUET AVE, CLOQUET, MN 55720-1622
(218) 878-0805
(218) 878-0794
Mailing address
1204 CLOQUET AVE, PO BOX 407, CLOQUET, MN 55720-1622
(218) 878-0805
(218) 878-0794
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4406
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806518700
—
MN
01
—
DC4813
MEDICARE RAILROAD
—
01
—
N010204
TRICARE
MN
Enumeration date
03/10/2006
Last updated
11/21/2007
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