Healthcare Provider Details

I. General information

NPI: 1659206506
Provider Name (Legal Business Name): ANNEMARIE ELIZABETH ROSCOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

2609 HAYES DR
BURNSVILLE MN
55337-1059
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7000
  • Fax:
Mailing address:
  • Phone: 612-965-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: