Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9034 | MN |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1275893943 |
---|---|
Provider Name | Andrea Catherine Mierau |
First Address | Bloomington, MN 55437-1111 |
Second Address | Blaine, MN 55449-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 09/02/2022 |