Provider Demographics
NPI:1972516227
Name:WERNER, AMBER RAE (PT, ATC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:WERNER
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMBRIDGE ST
Mailing Address - Street 2:APT #200
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8194
Mailing Address - Country:US
Mailing Address - Phone:952-920-2524
Mailing Address - Fax:
Practice Address - Street 1:7707 FLYING CLOUD DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3708
Practice Address - Country:US
Practice Address - Phone:952-829-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM525P1FLOtherBCBS GROUP #
MN527P1WEOtherBCBS PROVIDER #
MN64-03962Medicaid
MN64-03962Medicaid