Provider Demographics
NPI:1386082139
Name:RALLIS, ANNE FRAZIER (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:FRAZIER
Last Name:RALLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6936 PINE ARBOR DR S STE 150
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4672
Mailing Address - Country:US
Mailing Address - Phone:651-459-2730
Mailing Address - Fax:
Practice Address - Street 1:6936 PINE ARBOR DR S STE 150
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4672
Practice Address - Country:US
Practice Address - Phone:651-459-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9337225100000X
KS11-04603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist