Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Minnesota Medical and Rehabilitative Services, LLC

Organization Physical Therapist · NPI 1154302545

Minnesota Medical and Rehabilitative Services, LLC provides Physical Therapist services in St Louis Park, Minnesota. Licensed in Minnesota. Registered with an NPI since 2005.

Licensed in
MN
In the registry since
2005
Specialties on file
6
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4201 Excelsior Blvd
St Louis Park, MN 55416-4728
Phone: (952) 564-3880
Fax: (952) 945-9536
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1544 (MN)
Physical Therapist Taxonomy 225100000X · Licence 5806 (MN)
Physical Therapist Taxonomy 225100000X · Licence 2264 (MN)
Occupational Therapist Taxonomy 225X00000X · Licence 102980 (MN)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence 5169 (MN)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence 6034 (MN)

Record details

NPI number1154302545
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jacob Mirman — Managing Partner · (952) 933-8900
Other names Minnesota Medical And Rehabilitation
NPI enumeratedNovember 11, 2005
Last updated in NPPESSeptember 18, 2025
Certification dateSeptember 18, 2025
Mailing address4201 Excelsior Blvd, St Louis Park, MN 55416-4728

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