Provider Demographics
NPI:1831629849
Name:BOSMA, BRIANNA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:BOSMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5551 SHORE TRL NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1275
Mailing Address - Country:US
Mailing Address - Phone:612-716-9997
Mailing Address - Fax:
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-831-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist