Healthcare Provider Details

I. General information

NPI: 1760955389
Provider Name (Legal Business Name): AMBER N MENNEMEYER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METHODIST HOSPITAL 6500 EXCELSIOR BLVD
MINNEAPOLIS MN
55426
US

IV. Provider business mailing address

4501 PARK GLEN RD APT 213
ST LOUIS PARK MN
55416-4873
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5000
  • Fax:
Mailing address:
  • Phone: 636-295-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11371
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: