Individual
MR. FRED SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.T.
Contact information
Practice address
1919 S 7TH ST, BRAINERD, MN 56401-4523
(218) 825-0913
(218) 828-1947
Mailing address
804 WRIGHT ST, BRAINERD, MN 56401-4441
(218) 825-0913
(218) 828-1947
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5456
MN
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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