OrganizationActive
Center for Primary Care and Rehabilitation, PA
NPI 1780963355 · Rehabilitation Practitioner · Eagan, MN
Provider details
- NPI number
- 1780963355
- Entity type
- Organization
- Primary specialty
- Rehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Elena Polukhin, Owner/Medical Director(651) 789-8022
- License
- 45600 (MN)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
880 Blue Gentian Rd Ste 165
Eagan, MN 55121-1772
Phone: (651) 789-8022
Fax: (651) 789-8028
Approximate (ZIP-level) locationGet directions
Mailing address
3006 Frank St
Maplewood, MN 55109-5501
Registry dates
- Enumerated
- 2011-08-12
- Last updated
- 2011-08-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.