# CHILDREN'S THERAPY CTR, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053450742
- **Authorized official:** SUSAN ANN FULLER OTRL (OWNER)
- **Authorized official phone:** (651) 994-9644

## Contact information

- **Practice address:** 3455 153RD ST W, ROSEMOUNT, MN 55068-4946
- **Practice address phone:** (651) 423-0644
- **Mailing address:** 4058 DEERWOOD TRL, EAGAN, MN 55122-1889
- **Mailing address phone:** (651) 994-9644
- **Mailing address fax:** (651) 994-8962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | — | MN | — |
| 225XP0200X | Pediatric Occupational Therapist | — | MN | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | Yes |
| 235Z00000X | Speech-Language Pathologist | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 09/23/2026

## 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 |