Healthcare Provider Details

I. General information

NPI: 1184117335
Provider Name (Legal Business Name): LYNDSEY WUNDERLICH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 1ST ST NE STE 101
LITTLE FALLS MN
56345-4635
US

IV. Provider business mailing address

309 1ST ST NE STE 101
LITTLE FALLS MN
56345-4635
US

V. Phone/Fax

Practice location:
  • Phone: 320-631-2302
  • Fax:
Mailing address:
  • Phone: 320-631-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: