Provider Demographics
NPI:1275893943
Name:MIERAU, ANDREA CATHERINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CATHERINE
Last Name:MIERAU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CATHERINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4801 W 81ST ST STE 112
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1111
Mailing Address - Country:US
Mailing Address - Phone:952-345-3000
Mailing Address - Fax:
Practice Address - Street 1:1630 101ST AVE NE STE 160
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-3403
Practice Address - Country:US
Practice Address - Phone:952-345-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251N0400X
MN9034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology