Provider Demographics
NPI:1053791905
Name:SOUTHPOINTE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SOUTHPOINTE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KALID
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-223-8879
Mailing Address - Street 1:1305 E 24TH STREET SUITE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-223-8879
Mailing Address - Fax:
Practice Address - Street 1:1305 E 24TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3927
Practice Address - Country:US
Practice Address - Phone:612-223-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy