Individual
LAURIE T JUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
621 DEMERS AVE, EAST GRAND FORKS, MN 56721-1833
(218) 733-5858
Mailing address
621 DEMERS AVE, EAST GRAND FORKS, MN 56721-1833
(218) 733-5858
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4364
MN
225100000X
Physical Therapist
884
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2685053
UNITED HEALTH CARE
—
01
—
26929
BC/BS
ND
05
—
353264000
—
MN
05
—
51158
—
ND
01
—
547G3JU
BC/BS
MN
01
—
64-06630
MEDICA
—
Enumeration date
06/23/2006
Last updated
04/21/2011
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