Individual
MS. LARA O STANISLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2151 HAMLINE AVE N, SUITE #111, ROSEVILLE, MN 55113-4236
(651) 636-5560
Mailing address
1957 PORTLAND AVE, SAINT PAUL, MN 55104-5853
(651) 402-5055
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8906
MN
Other
Enumeration date
07/13/2013
Last updated
07/13/2013
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