Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Minnesota Medical and Rehabilitative Services, LLC

Organization Physical Therapist · NPI 1154302545

Minnesota Medical and Rehabilitative Services, LLC is a Physical Therapist 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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