Basic Information
| Provider Information | |||||||||
| NPI: | 1598967390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZENBY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HAEGELE | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7581 9TH ST N | ||||||||
| Address2: | STE 100 | ||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551286635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517484338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 404 HIGHWAY 96 W | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SHOREVIEW | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551261901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517654103 | ||||||||
| FaxNumber: | 6517654108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9517 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 8232 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.