Basic Information
| Provider Information | |||||||||
| NPI: | 1194915587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARUSKA | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | LYNN SOMMARS | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18650 NW CORNELL RD STE 314 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971249212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032169760 | ||||||||
| FaxNumber: | 5032169765 | ||||||||
| Practice Location | |||||||||
| Address1: | 8301 GOLDEN VALLEY RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635330541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5007 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.