Individual
HUNTER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
625 DEMERS AVE, EAST GRAND FORKS, MN 56721-1833
(218) 773-5858
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2703
ND
Other
Enumeration date
06/03/2024
Last updated
07/13/2024
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