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NPI Code Detail

MEDICARE: NICOLE M LAVANTY MSPT

MEDICARE: NICOLE M LAVANTY MSPT
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
1225100000XPhysical Therapist7672MN

General Provider Information

NPI Number : 1851373609
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE M LAVANTY MSPT
Provider Business Mailing Address
First Line : 6515 BARRIE RD
Second Line : SUITE 100
City : EDINA
State : MN
Zip : 55435-2305
Country : US
Telephone Number : 952-922-5019
Fax Number : 952-922-1384
Provider Business Practice Location Address
First Line : 715 S 8TH ST FL 3
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-7530
Country : US
Telephone Number : 612-873-4524
Fax Number : 612-873-1608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 11/19/2024

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Directions to “ NICOLE M LAVANTY MSPT” Practice Location

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