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General NPI Number Information
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NPI Number | 1740881283
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Entity Type | Individual
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Provider Name | ANNA PEDERSEN DPT
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 471 S ARCH AVE
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1832
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Country | US
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Telephone | 715-246-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 628 GRAND AVE APT 108
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City | SAINT PAUL
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State | MN
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Zip | 55105-3408
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Country | US
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Telephone | 651-387-0417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12087
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License Number State | MN
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