Provider Demographics
NPI:1679771885
Name:HOLMES, ANNA SOPHIE (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:SOPHIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1506
Mailing Address - Country:US
Mailing Address - Phone:952-935-4037
Mailing Address - Fax:952-908-0361
Practice Address - Street 1:15000 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1506
Practice Address - Country:US
Practice Address - Phone:952-935-4037
Practice Address - Fax:952-908-0361
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6B478OROtherBLUE CROSS BLUE SHIELD GR
MN1024610OtherPREFFERED ONE
MN217L2HOOtherBLUE CROSS BLUE SHEILD