Healthcare Provider Details

I. General information

NPI: 1821476862
Provider Name (Legal Business Name): LISA VIGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15111 TWELVE OAKS CENTER DR
MINNETONKA MN
55305-5201
US

IV. Provider business mailing address

15111 TWELVE OAKS CENTER DR
MINNETONKA MN
55305-5201
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4500
  • Fax:
Mailing address:
  • Phone:
  • 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: