Provider Demographics
NPI:1467659649
Name:OOMMEN, ANNA ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 94TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2453
Mailing Address - Country:US
Mailing Address - Phone:651-707-5746
Mailing Address - Fax:
Practice Address - Street 1:COURAGE CENTER
Practice Address - Street 2:3915 GOLDEN VALLEY ROAD
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-0373
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant