Organization
ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC
Active
Organization
ORTHOPEDIC & SPORTS PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWN MARIE KRAUSE ROBERTS PT/ATC (PRESIDENT)
(218) 641-7725
Entity
Organization
Contact information
Practice address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
(218) 641-6625
Mailing address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
(218) 641-6625
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1180
ND
225100000X
Physical Therapist
6521
MN
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057K80R
MN BCBS
MN
01
—
101592300
US DEPT OF LABOR
MN
01
—
1041486
PREFERRED ONE
MN
01
—
121G4OR
MN BCBS FOR OT'S
MN
05
—
1458152
—
ND
05
—
148478000
—
MN
01
—
96570
HEALTH PARTNERS
MN
01
—
DD3739
RR MEDICARE
MN
Enumeration date
06/24/2006
Last updated
01/10/2018
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