Basic Information
Provider Information
NPI: 1619376738
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAUL
FirstName: ANNA
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SIMONSON
OtherFirstName: ANNA
OtherMiddleName: ELIZABETH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 710 COMMERCE DR STE 200
Address2:  
City: WOODBURY
State: MN
PostalCode: 551254925
CountryCode: US
TelephoneNumber: 6519685042
FaxNumber: 6519685904
Practice Location
Address1: 2090 WOODWINDS DR
Address2:  
City: WOODBURY
State: MN
PostalCode: 551254925
CountryCode: US
TelephoneNumber: 6519685801
FaxNumber: 6519685899
Other Information
ProviderEnumerationDate: 08/14/2014
LastUpdateDate: 09/27/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X9770MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


Home