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Organization
CHILDREN'S THERAPY CTR, INC
Active
Organization
CHILDREN'S THERAPY CTR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ANN FULLER OTRL (OWNER)
(651) 994-9644
Entity
Organization
Contact information
Practice address
3455 153RD ST W, ROSEMOUNT, MN 55068-4946
(651) 423-0644
Mailing address
4058 DEERWOOD TRL, EAGAN, MN 55122-1889
(651) 994-9644
(651) 994-8962
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
MN
225XP0200X
Pediatric Occupational Therapist
—
MN
235Z00000X
Speech-Language Pathologist
Primary
—
NULL
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043755700
—
MN
01
—
105647
HEALTHPARTNERS
MN
01
—
521091043137
PREFERRED ONE
MN
01
—
7610098
AETNA
MN
01
—
960S0CH
BCBS OT
MN
01
—
962S7CH
BCBS SP
MN
01
—
965S5CH
BCBS PT
MN
Enumeration date
02/06/2007
Last updated
09/23/2026
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