Provider Demographics
NPI:1467757104
Name:SULERUD, LIV (NCTMB)
Entity Type:Individual
Prefix:
First Name:LIV
Middle Name:
Last Name:SULERUD
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E 48TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1067
Mailing Address - Country:US
Mailing Address - Phone:952-657-8833
Mailing Address - Fax:
Practice Address - Street 1:812 E 48TH ST STE 4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1067
Practice Address - Country:US
Practice Address - Phone:952-657-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist