Healthcare Provider Details

I. General information

NPI: 1588784904
Provider Name (Legal Business Name): LISA A HUXHOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 W BROADWAY AVE
ROBBINSDALE MN
55422-5604
US

IV. Provider business mailing address

11231 RHODE ISLAND AVE N
CHAMPLIN MN
55316-3243
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: