Provider Demographics
NPI:1326838525
Name:COUSINEAU, SOPHIA (DPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:COUSINEAU
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S DEEP LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6313
Mailing Address - Country:US
Mailing Address - Phone:617-615-3779
Mailing Address - Fax:
Practice Address - Street 1:8100 HIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1006
Practice Address - Country:US
Practice Address - Phone:617-615-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist