Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | MN |
NPI | 1073929543 |
---|---|
Provider Name | Dr. Lucas G Dueffert |
First Address | St Louis Park, MN 55426-1058 |
Second Address | Wayzata, MN 55391-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2014 |
Last Update Date | 06/07/2014 |