Healthcare Provider Details

I. General information

NPI: 1720335482
Provider Name (Legal Business Name): JANE ROSEANN ANDERBERG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2012
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 RICHARD AVE STE 102
HERMANTOWN MN
55811-2979
US

IV. Provider business mailing address

1939 MINNEHAHA AVE W STE 300
SAINT PAUL MN
55104-1033
US

V. Phone/Fax

Practice location:
  • Phone: 218-206-7775
  • Fax: 218-206-7776
Mailing address:
  • Phone: 651-748-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0011875
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13841
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: