Provider Demographics
NPI:1205802576
Name:LERUD, LUANN K (PT)
Entity type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:K
Last Name:LERUD
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 1:11038 217TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-9257
Mailing Address - Country:US
Mailing Address - Phone:763-441-3937
Mailing Address - Fax:
Practice Address - Street 1:21395 JOHN MILLESS DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4406
Practice Address - Country:US
Practice Address - Phone:763-428-2589
Practice Address - Fax:763-428-4672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist