Healthcare Provider Details

I. General information

NPI: 1770628356
Provider Name (Legal Business Name): MANDY LABROSSE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 COLORADO ST SE STE 2
PRIOR LAKE MN
55372-4548
US

IV. Provider business mailing address

1939 MINNEHAHA AVE W STE 300
SAINT PAUL MN
55104-1033
US

V. Phone/Fax

Practice location:
  • Phone: 952-936-9600
  • Fax: 952-936-9536
Mailing address:
  • Phone: 651-748-4338
  • Fax: 651-748-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018539
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8448
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: