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NPI Code Detail

MEDICARE: MR. BRIAN M OMMEN

MEDICARE: MR. BRIAN M OMMEN
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 Therapist8474MN

General Provider Information

NPI Number : 1417185182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN M OMMEN
Provider Business Mailing Address
First Line : 7872 CENTURY BLVD
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317
Country : US
Telephone Number : 952-448-9081
Fax Number : 952-448-9088
Provider Business Practice Location Address
First Line : 7872 CENTURY BLVD
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317-8005
Country : US
Telephone Number : 952-448-9081
Fax Number : 952-448-9088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2009
Last Update Date : 07/14/2011

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