Healthcare Provider Details

I. General information

NPI: 1881790665
Provider Name (Legal Business Name): AMY J PROSE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY J SPRADO

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 81ST ST STE 103
BLOOMINGTON MN
55437-1111
US

IV. Provider business mailing address

4801 W 81ST ST STE 103
BLOOMINGTON MN
55437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-0199
  • Fax:
Mailing address:
  • Phone: 952-924-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6146
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: