1972821874 NPI number — THE BACK PROGRAM

Table of content: EMILY HG DUNCAN LCSW (NPI 1093375693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972821874 NPI number — THE BACK PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BACK PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972821874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 SO OAK AVE
Provider Second Line Business Mailing Address:
SUITE 2 OWATONNA PHYSICAL THERAPY CENTER INC
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-451-8254
Provider Business Mailing Address Fax Number:
507-451-7324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 SO OAK AVE
Provider Second Line Business Practice Location Address:
STE 2 OWATONNA PHYSICAL THERAPY CENTER INC
Provider Business Practice Location Address City Name:
OWATONNA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55060-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-451-8254
Provider Business Practice Location Address Fax Number:
507-451-7324
Provider Enumeration Date:
05/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETERSON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-451-8254

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6296 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)