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NPI Code Detail

MEDICARE: TAMARA LU FELEGY M.P.T.

MEDICARE: TAMARA LU FELEGY M.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4919MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
199F92FEOTHERMNBCBS INDIVIDUAL NUMBER
299F90PROTHERMNBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1134233018
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA LU FELEGY M.P.T.
Provider Business Mailing Address
First Line : 545 3RD AVE NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-6841
Country : US
Telephone Number : 651-636-0903
Fax Number :
Provider Business Practice Location Address
First Line : 1405 SILVER LAKE RD NW
Second Line : SUITE 8
City : NEW BRIGHTON
State : MN
Zip : 55112-9301
Country : US
Telephone Number : 651-206-9702
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 07/09/2007

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