Provider Demographics
NPI:1194915587
Name:MARUSKA, CARRIE LYNN SOMMARS (DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN SOMMARS
Last Name:MARUSKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18650 NW CORNELL RD STE 314
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9212
Mailing Address - Country:US
Mailing Address - Phone:503-216-9760
Mailing Address - Fax:503-216-9765
Practice Address - Street 1:8301 GOLDEN VALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:763-533-0541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist