Provider Demographics
NPI:1134663230
Name:STREET, LASHAWN (LMT)
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7714 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2980
Mailing Address - Country:US
Mailing Address - Phone:651-528-0127
Mailing Address - Fax:
Practice Address - Street 1:7714 BROOKLYN BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443-2980
Practice Address - Country:US
Practice Address - Phone:651-528-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist