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NPI Code Detail

MEDICARE: GINA LAKOUR PTA

MEDICARE: GINA LAKOUR PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1346455904
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA LAKOUR PTA
Provider Business Mailing Address
First Line : 3700 CEDAR LAKE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4240
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3700 CEDAR LAKE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4240
Country : US
Telephone Number : 612-925-7247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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