Organization
OPTIMAL SPORTS PHYSICAL THERAPY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL ARTHUR BERG JR. PT (OWNER)
(952) 758-7014
Entity
Organization
Contact information
Practice address
1400 1ST ST NE, NEW PRAGUE, MN 56071-2215
(952) 758-2535
Mailing address
801 HERITAGE TRL, NEW PRAGUE, MN 56071-2200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5990
MN
225100000X
Physical Therapist
6759
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14N26OP
MN BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/25/2006
Last updated
01/17/2008
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