MEDICARE: LTC PROFESSIONALS, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	171100000X	Acupuncturist
3	207Q00000X	Family Medicine Physician
4	261QH0100X	Health Service Clinic/Center
5	261QP3300X	Pain Clinic/Center
6	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	535	OTHER	TN	TONIC BIOREGULATORY MEDICINE

General Provider Information

NPI Number	:	1417251935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LTC PROFESSIONALS, PLLC

Provider Business Mailing Address
First Line	:	7801 EAST BUSH LAKE RD
Second Line	:	SUITE 400
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439
Country	:	US
Telephone Number	:	952-479-4261
Fax Number	:	866-991-7241

Provider Business Practice Location Address
First Line	:	7801 EAST BUSH LAKE RD
Second Line	:	SUITE 400
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439
Country	:	US
Telephone Number	:	952-479-4261
Fax Number	:	866-991-7241

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KURT LARSON
Credential	:
Telephone Number	:	952-479-4261

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	07/25/2024

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Directions to “LTC PROFESSIONALS, PLLC ” Practice Location

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