Provider Demographics
NPI:1770616849
Name:PLASENCIA, THERESA IRENE (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:IRENE
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:981 CHATSWORTH PL
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 COUNTY ROAD E W STE 240
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8153
Practice Address - Country:US
Practice Address - Phone:651-493-0626
Practice Address - Fax:651-493-8463
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN59302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
5606571OtherFIRST HEALTH
MN109313OtherHEALTHPARTNERS
MN64-04673OtherMEDICA
MN60M64PLOtherBLUECROSS AND BLUE SHIELD
MN60M64PLOtherBLUECROSS AND BLUE SHIELD