Provider Demographics
NPI:1851420889
Name:MEYER, TERESA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:MEYER
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 1:18680 GARNET ST NW
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9534
Mailing Address - Country:US
Mailing Address - Phone:763-753-0496
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 400
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2776
Practice Address - Country:US
Practice Address - Phone:763-236-8911
Practice Address - Fax:763-236-8930
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND503225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant