Provider Demographics
NPI:1982649976
Name:LEERSSEN, STUART THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:THOMAS
Last Name:LEERSSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:THOMAS
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:832 FIRST STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1245
Mailing Address - Country:US
Mailing Address - Phone:218-885-1282
Mailing Address - Fax:218-885-1471
Practice Address - Street 1:832 FIRST STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1245
Practice Address - Country:US
Practice Address - Phone:218-885-1282
Practice Address - Fax:218-885-1471
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist