Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 7162 | MN |
N | 2251N0400X | Physical Therapist - Neurology | 7162 | MN |
N | 2251P0200X | Physical Therapist - Pediatrics | 7162 | MN |
N | 2251X0800X | Physical Therapist - Orthopedic | 7162 | MN |
NPI | 1063617306 |
---|---|
Provider Name | Ms. Crystal Marie Luxmore |
First Address | New Market, MN 55054-5452 |
Second Address | Minneapolis, MN 55423-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |