Provider Demographics
NPI:1093007577
Name:SLAASTAD, SIGURD TORE (PT)
Entity Type:Individual
Prefix:MR
First Name:SIGURD
Middle Name:TORE
Last Name:SLAASTAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 ATTARD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6814
Mailing Address - Country:US
Mailing Address - Phone:248-885-8816
Mailing Address - Fax:
Practice Address - Street 1:2210 ATTARD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6814
Practice Address - Country:US
Practice Address - Phone:248-885-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist