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NPI Code Detail

MEDICARE: AMY SUE ANDERSEN MPT

MEDICARE: AMY SUE ANDERSEN MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6280MN

General Provider Information

NPI Number : 1063591840
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY SUE ANDERSEN MPT
Provider Business Mailing Address
First Line : 7645 BEHM LN
Second Line :
City : LINO LAKES
State : MN
Zip : 55014-2902
Country : US
Telephone Number : 651-784-7389
Fax Number :
Provider Business Practice Location Address
First Line : 1970 OAKCREST AVE
Second Line : SUITE 107
City : ROSEVILLE
State : MN
Zip : 55113-2624
Country : US
Telephone Number : 651-636-6330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/31/2008

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Directions to “ AMY SUE ANDERSEN MPT” Practice Location

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