Individual
SANDRA LAVERNE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2835 W SAINT GERMAIN ST, SUITE 300, SAINT CLOUD, MN 56301-4743
(320) 259-4151
(320) 259-5707
Mailing address
2835 W SAINT GERMAIN ST, SUITE 300, SAINT CLOUD, MN 56301-4743
(320) 259-4151
(320) 259-5707
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
MN5779
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03S81LA
BCBS PROVIDER ID
MN
01
—
41163580956301B011
CHAMPA PROVIDER ID
MN
01
—
6405071
MEDICA PROVIDER ID
MN
Enumeration date
04/12/2006
Last updated
07/08/2007
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