Organization
SPORTS ORTHOPEDIC ADVANCED REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA L. GURIN M.D. (PRESIDENT)
(952) 223-3339
Entity
Organization
Contact information
Practice address
4660 SLATER RD STE 240, EAGAN, MN 55122
(952) 223-3339
(952) 314-1401
Mailing address
4660 SLATER RD STE 240, EAGAN, MN 55122-4047
(952) 223-3339
(952) 314-1401
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
39052
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780910802
—
MN
01
—
C05426
MEDICARE PTAN
MN
Enumeration date
10/23/2009
Last updated
11/07/2019
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