Individual
STACEY LYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
923 HALE LAKE POINTE, GRAND RAPIDS, MN 55744-9615
(218) 326-0543
Mailing address
5786 MARTIMA RD, FLOODWOOD, MN 55736-8124
(218) 461-6403
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A2580
MN
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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