Provider Demographics
NPI:1083009674
Name:SAILER, LARA K (PT)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:K
Last Name:SAILER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:K
Other - Last Name:KARG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1661 SAINT ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-968-5335
Practice Address - Fax:651-730-3989
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9366OtherLICENSE