Sports Orthopedic Advanced Rehabilitation, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

39052 Issued in MN

Legal business name

SPORTS ORTHOPEDIC ADVANCED REHABILITATION, LLC

Practice address

4660 Slater Rd Ste 240
Eagan, MN 55122

Phone

(952) 223-3339

Fax

(952) 314-1401

NPI assigned

Oct 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Teresa L. Gurin, M.D.

Title

President

Phone

(952) 223-3339

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573084800000",
    "number": "1780910802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD STE 240",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "952-223-3339",
            "fax_number": "952-314-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD STE 240",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "952-223-3339",
            "fax_number": "952-314-1401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 Nicollet Mall",
            "address_2": "Suite 809",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554022604",
            "country_code": "US",
            "telephone_number": "952-223-3339",
            "fax_number": "952-314-1401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4660 Slater Rd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "55122",
            "country_code": "US",
            "telephone_number": "952-223-3339",
            "fax_number": "952-314-1401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORTS ORTHOPEDIC ADVANCED REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2019-11-07",
        "status": "A",
        "authorized_official_last_name": "GURIN",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-223-3339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "39052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C05426",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780910802",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southview Autism Services LLC
• Allie Spaulding, PT
• Joshua Speckman
• Spectrum Smiles LLC
• Samantha Spitzack
• Anthony Spurrill, D.C.
• Nicole Renee Squires
• Ssemee, Inc.
• St Paul Eye Clinic PA
• St Paul Rheumatology P a

• All providers in Eagan, MN
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.