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NPI Code Detail

MEDICARE: ANNEKA MARIE BOOMSMA DPT

MEDICARE: ANNEKA MARIE BOOMSMA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist13797MN

General Provider Information

NPI Number : 1598461352
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNEKA MARIE BOOMSMA DPT
Provider Business Mailing Address
First Line : 4225 GOLDEN VALLEY RD
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-4215
Country : US
Telephone Number : 763-588-0661
Fax Number : 763-282-2303
Provider Business Practice Location Address
First Line : 9645 GROVE CIR N STE 100
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55369-2682
Country : US
Telephone Number : 763-302-4114
Fax Number : 763-287-2303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2023
Last Update Date : 04/24/2026

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Directions to “ ANNEKA MARIE BOOMSMA DPT” Practice Location

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