Southgate Physical Therapy , LTD

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

669 Issued in MN

Legal business name

SOUTHGATE PHYSICAL THERAPY , LTD

Practice address

3017 Bloomington Ave
Minneapolis, MN 55407-1715

Phone

(612) 721-7981

Fax

(612) 721-7981

NPI assigned

May 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Susan Grimes

Title

Clinic Manager

Phone

(651) 905-3783

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730390899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 CENTRE POINTE CURV",
            "address_2": "#101",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201280",
            "telephone_number": "651-905-3783",
            "fax_number": "651-686-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071715",
            "telephone_number": "612-721-7981",
            "fax_number": "612-721-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE PHYSICAL THERAPY , LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "651-905-3783",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.