Great River Spine & Sport – Physical Therapist, NPI 1396775110

Great River Spine & Sport is a healthcare provider. based in Big lake, Minnesota. specializing in Physical Therapist. The organization holds a License No. 44760 (MN). The NPI Number for Great River Spine & Sport is 1396775110

Main info

Organization
Name
Great River Spine & Sport
NPI
1396775110
Phone
(763) 260-8401
Address
751 Rose Dr Ste 108
Authorized Official
BILL E MICKLE OWNER DC
Enumeration Date
4 July 2006
Last Update Date
18 October 2019
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience70
Completeness80
Years active:19State licenses:3Digital endpointsUpdated within 12 months

Provider Addresses for Great River Spine & Sport

  • 751 Rose Dr Ste 108

    Big Lake, MN 553098870

    Phone: (763) 260-8401

    Fax: (763) 273-8921

    Type: Location

  • 1260, MN 25, Monticello, Wright County, Minnesota, 55362, United States

    MONTICELLO, MN 553628921

    Phone: (763) 263-8401

    Fax: (763) 263-5900

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55309)

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Reviews

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Frequently asked questions

How is Great River Spine & Sport identified in CMS data?
CMS-hosted NPPES data lists Great River Spine & Sport with NPI 1396775110.
Does the file indicate Great River Spine & Sport is practicing under active NPI?
Directory data currently reports Great River Spine & Sport as active.
What taxonomy line describes Great River Spine & Sport?
For research purposes, treat Great River Spine & Sport as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Great River Spine & Sport?
Great River Spine & Sport's geographic hint is Big Lake, Minnesota in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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