Organization
ALANS PHYSICAL THERAPY OF GRAND RAPIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN JAY DETTMER PT (OWNER)
(218) 999-5554
Entity
Organization
Contact information
Practice address
111 GOLF COURSE RD, SUITE 2, GRAND RAPIDS, MN 55744-3526
(218) 999-5554
(218) 999-7620
Mailing address
111 GOLF COURSE RD, SUITE 2, GRAND RAPIDS, MN 55744-3526
(218) 999-5554
(218) 999-7620
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
7152
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962479436
—
MN
Enumeration date
03/17/2014
Last updated
06/26/2014
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