=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659544047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESE ANNE KOSCH RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 04/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 SMITH AVE N
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-241-8290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9296 AMSDEN WAY
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55347-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-942-8123
-----------------------------------------------------
Fax | 952-942-8523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2481
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------