Provider Demographics
NPI:1144587023
Name:METRO THERAPY SPECIAL CHILDREN'S CLINIC, INC
Entity type:Organization
Organization Name:METRO THERAPY SPECIAL CHILDREN'S CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-572-2519
Mailing Address - Street 1:5155 E RIVER RD STE 403
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3777
Mailing Address - Country:US
Mailing Address - Phone:762-572-2519
Mailing Address - Fax:763-572-2616
Practice Address - Street 1:5155 E RIVER RD STE 403
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-3777
Practice Address - Country:US
Practice Address - Phone:762-572-2519
Practice Address - Fax:763-572-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty