Healthcare Provider Details

I. General information

NPI: 1982138020
Provider Name (Legal Business Name): ERIENNE LAUERSDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 04/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

W4801 THRUSH RD
WATERTOWN WI
53098-4742
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax:
Mailing address:
  • Phone: 920-988-5893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: