Phenom Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHENOM PHYSICAL THERAPY INC

Practice address

703 Thielen Dr
Saint Michael, MN 55376-9613

Phone

(763) 497-1153

Fax

(763) 497-5256

NPI assigned

Jun 7, 2016

Organization subpart

No

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

Authorized official

Name

Craig L Butturff, MSPT

Title

Owner

Phone

(320) 543-1104

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480982400000",
    "number": "1902255383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553490737",
            "telephone_number": "320-543-1104",
            "fax_number": "320-543-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 THIELEN DR",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553769613",
            "telephone_number": "763-497-1153",
            "fax_number": "763-497-5256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHENOM PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-12-06",
        "status": "A",
        "authorized_official_last_name": "BUTTURFF",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-543-1104",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Saint Michael, MN
• Providers in Saint Michael, MN by specialty
• Physical Therapy Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; 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.