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NPI Code Detail

MEDICARE: ANNAMARIA MCCONVILLE P.T.

MEDICARE: ANNAMARIA MCCONVILLE P.T.
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 Therapist7889MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171L65MCOTHERMNBCBS OF MN
2HP85049OTHERMNHEALTHPARTNERS
31831231281OTHERMNAMERICA'S PPO
46408307OTHERMNMEDICA
5962871052892OTHERMNPREFERRED ONE

General Provider Information

NPI Number : 1831231281
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNAMARIA MCCONVILLE P.T.
Provider Business Mailing Address
First Line : 4014 RUSSELL AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1546
Country : US
Telephone Number : 612-845-0707
Fax Number :
Provider Business Practice Location Address
First Line : 2125 E HENNEPIN AVE STE 300
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1763
Country : US
Telephone Number : 612-750-7168
Fax Number : 612-564-7373
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/19/2019

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Directions to “ ANNAMARIA MCCONVILLE P.T.” Practice Location

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