Provider Demographics
NPI:1003580051
Name:LAHOUD, KAYLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:
Last Name:LAHOUD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 INTERLACHEN RD APT 412
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9770
Mailing Address - Country:US
Mailing Address - Phone:218-393-5792
Mailing Address - Fax:
Practice Address - Street 1:7550 34TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55450-2601
Practice Address - Country:US
Practice Address - Phone:612-727-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist