Doctor Name: | MR. FRED SOUKUP |
NPI Number: | 1861688442 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.T. |
License Number: | 5456 |
Business Practice Address: | 1919 S 7th St Brainerd, MN - 564014523 |
Business Phone Number: | 2188250913 |
Business Fax Number: | 2188281947 |
Mailing Address: | 804 Wright St, BRAINERD |
State: | MN |
Postal Code: | 564014441 |
Phone Number: | 2188250913 |
Fax Number: | 2188281947 |
NPI Enumeration Date: | 09/18/2007 |
NPI Last Update Date: | 09/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5456 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |