Provider Demographics
NPI:1518110576
Name:BOLLMEYER, LAUREEN KAY (PT)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:KAY
Last Name:BOLLMEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:STE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:STE A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4872
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN3AF68BOOtherBLUE CROSS BLUE SHIELD OF MN
MNHP106313OtherHEALTHPARTNERS
MN1518110576Medicaid
MN64-09720OtherMEDICA
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN1518110576Medicaid
MN650002171Medicare PIN