NPI 1790787216
Land of Lakes Orthotics & Prosthetics
Practice location
- Address
- 14395 23rd Ave N, Plymouth, MN 55447-4704
- Phone
- (952) 745-3004
- Fax
- (952) 745-3010
Authorised official
- Name
- Clark V Poulson
- Title
- Prosthetist Orthotist
- Phone
- (952) 745-3004
Registered specialties
Prosthetic/Orthotic Supplier
Primary
Registry record
- NPI
- 1790787216
- Entity type
- Organization
- NPI issued
- 15 Aug 2005
- Record last updated
- 26 May 2011
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.