Provider Demographics
NPI: | 1821235367 |
---|---|
Name: | BISSON, TERESA ANN (PT, MSPT, NCS, ATP) |
Entity Type: | Individual |
Prefix: | |
First Name: | TERESA |
Middle Name: | ANN |
Last Name: | BISSON |
Suffix: | |
Gender: | F |
Credentials: | PT, MSPT, NCS, ATP |
Other - Prefix: | |
Other - First Name: | TERESA |
Other - Middle Name: | ANN |
Other - Last Name: | OKRASZEWSKI |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 420 DELAWARE STREET SE |
Mailing Address - Street 2: | MMC 388 |
Mailing Address - City: | MINNEAPOLIS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55455 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 612-624-2364 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2200 UNIVERSITY AVE W STE 140 |
Practice Address - Street 2: | |
Practice Address - City: | SAINT PAUL |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55114-1844 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-672-2815 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-01-20 |
Last Update Date: | 2021-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PT27495 | 225100000X |
MN | 9893 | 2251N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |