# LAKE SUPERIOR PHYSICAL THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164429163
- **Authorized official:** TERRI L WALLEN (BUSINESS MANAGER)
- **Authorized official phone:** (218) 625-6300

## Contact information

- **Practice address:** 215 N CENTRAL AVE, 14B, DULUTH, MN 55807-2402
- **Practice address phone:** (218) 625-6300
- **Practice address fax:** (218) 724-6700
- **Mailing address:** 215 N CENTRAL AVE, 14B, DULUTH, MN 55807-2402
- **Mailing address phone:** (218) 625-6300
- **Mailing address fax:** (218) 724-6700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2005
- **Last updated:** 02/25/2015