Provider Demographics
NPI:1326684556
Name:JAEGER, LAURA LEA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:JAEGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEA
Other - Last Name:BONSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:929 RUSSELL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3872
Mailing Address - Country:US
Mailing Address - Phone:651-769-4509
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DR STE 313
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist