Provider Demographics
NPI:1265842264
Name:TESSMAN, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:TESSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005
Mailing Address - Country:US
Mailing Address - Phone:651-674-7589
Mailing Address - Fax:
Practice Address - Street 1:1574 154TH AVE NW
Practice Address - Street 2:SUITE 109
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4788
Practice Address - Country:US
Practice Address - Phone:763-433-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist