Organization
MIKA THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY MICHAEL GATES (CEO)
(952) 288-5328
Entity
Organization
Contact information
Practice address
13335 PALOMINO DR, SUITE 202, APPLE VALLEY, MN 55124-4248
(651) 332-2539
(651) 332-2540
Mailing address
13335 PALOMINO DR, SUITE 202, APPLE VALLEY, MN 55124-4248
(651) 332-2539
(651) 332-2540
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2803227-2
MN
Other
Enumeration date
07/21/2009
Last updated
07/21/2009
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