Provider Demographics
NPI:1396957304
Name:ANDERSON, RHONDA LEE (PT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:LEE
Other - Last Name:MALINOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:12335 NORWAY ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448
Mailing Address - Country:US
Mailing Address - Phone:763-757-3547
Mailing Address - Fax:
Practice Address - Street 1:550 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2799
Practice Address - Country:US
Practice Address - Phone:763-236-3000
Practice Address - Fax:763-236-3066
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist