Provider Demographics
NPI:1013017813
Name:BOOSALIS, CHRIS PETER (CERTIFIED PROSTHETIS)
Entity Type:Individual
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First Name:CHRIS
Middle Name:PETER
Last Name:BOOSALIS
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Gender:M
Credentials:CERTIFIED PROSTHETIS
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:6600 FRANCE AVE S
Practice Address - Street 2:SUITE 162
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1805
Practice Address - Country:US
Practice Address - Phone:952-929-1051
Practice Address - Fax:952-929-9641
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-04-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist