Provider Demographics
NPI:1831231281
Name:MCCONVILLE, ANNAMARIA (PT)
Entity type:Individual
Prefix:
First Name:ANNAMARIA
Middle Name:
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 RUSSELL AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1546
Mailing Address - Country:US
Mailing Address - Phone:612-845-0707
Mailing Address - Fax:
Practice Address - Street 1:2125 E HENNEPIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1763
Practice Address - Country:US
Practice Address - Phone:612-750-7168
Practice Address - Fax:612-564-7373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN71L65MCOtherBCBS OF MN
MNHP85049OtherHEALTHPARTNERS
MN1831231281OtherAMERICA'S PPO
MN6408307OtherMEDICA
MN962871052892OtherPREFERRED ONE