Provider Demographics
NPI:1629356076
Name:AHMANN, ALISSA RAE (PT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:RAE
Last Name:AHMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:RAE
Other - Last Name:PAULY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
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:952-512-5651
Practice Address - Street 1:6350 W 143RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-3000
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist