Organization
PROFESSIONAL PHYSICAL THERAPY PA
Active
Other names
Pro Physical Therapy PA
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FRICKE PT (OWNER)
(952) 891-2645
Entity
Organization
Contact information
Practice address
13786 FRONTIER CT, #102, BURNSVILLE, MN 55337
(952) 891-2645
(952) 997-3410
Mailing address
27 MARCIN HILL, BURNSVILLE, MN 55337
(952) 891-2645
(952) 997-3410
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2187
MN
2251X0800X
Orthopedic Physical Therapist
2187
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012293
PREFERRED ONE
MN
01
—
264019500
US DEPT OF LABOR
MN
01
—
6407997
MEDICA
MN
01
—
7G667PR
BCBS OF MN
MN
Enumeration date
01/29/2007
Last updated
06/23/2008
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