Healthcare Provider Details

I. General information

NPI: 1194915587
Provider Name (Legal Business Name): CARRIE LYNN SOMMARS MARUSKA D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 GOLDEN VALLEY RD STE 202
GOLDEN VALLEY MN
55427
US

IV. Provider business mailing address

18650 NW CORNELL RD STE 314
HILLSBORO OR
97124-9212
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-0541
  • Fax:
Mailing address:
  • Phone: 503-216-9760
  • Fax: 503-216-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5007
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: