Individual
MARY ANNE TINGUELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9220 BASS LAKE RD STE 260, NEW HOPE, MN 55428-3019
(763) 533-0363
Mailing address
719 MCGRAW DR, FORT COLLINS, CO 80526-3978
(970) 222-8274
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT1378
ME
2251P0200X
Pediatric Physical Therapist
Primary
9273
MN
2251P0200X
Pediatric Physical Therapist
9760
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022801
ANTHEM MAINE
ME
01
—
1283903
AETNA
ME
05
—
235380099
—
ME
Enumeration date
02/14/2007
Last updated
03/08/2019
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