Provider Demographics
NPI:1255777140
Name:HANDT, MARY LOIS LUNDEMO (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOIS LUNDEMO
Last Name:HANDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:LOIS
Other - Last Name:LUNDEMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10232 COLORADO RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1842
Mailing Address - Country:US
Mailing Address - Phone:952-893-0513
Mailing Address - Fax:
Practice Address - Street 1:10232 COLORADO RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1842
Practice Address - Country:US
Practice Address - Phone:952-893-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist