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General NPI Number Information
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NPI Number | 1982965505
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Entity Type | Organization
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Legal Business Name | FSMINNESOTAONE LLC
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 7060 VALLEY CREEK PLZ SUITE 113
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City | WOODBURY
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State | MN
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Zip | 55125-2269
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Country | US
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Telephone | 651-739-3668
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Fax | 651-739-3678
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Provider Business Mailing Address
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Address Line | 7060 VALLEY CREEK PLZ SUITE 113
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City | WOODBURY
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State | MN
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Zip | 55125-2269
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Country | US
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Telephone | 651-739-3668
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Fax | 651-739-3678
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Authorized Official
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Title or Position | CERTIFIED PEDORTHIST
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Name | MR. TED LOWE
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Credential | C.PED
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Telephone | 651-739-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 39232252
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License Number State | MN
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