Organization
SPORTS ORTHOPEDIC ADVANCED REHABILITATION, LLC
Active
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
Update your record
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