Provider Demographics
NPI:1366328783
Name:MOMO AZAMBOU, VALENTINE
Entity type:Individual
Prefix:
First Name:VALENTINE
Middle Name:
Last Name:MOMO AZAMBOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 WASHINGTON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1339
Mailing Address - Country:US
Mailing Address - Phone:651-246-4371
Mailing Address - Fax:651-646-0538
Practice Address - Street 1:3435 WASHINGTON DR STE 104
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1339
Practice Address - Country:US
Practice Address - Phone:651-246-4371
Practice Address - Fax:651-646-0538
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist