Provider Demographics
NPI:1548693815
Name:LAUER, ELIZABETH LYNN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:LAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:DESANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3445 BLAISDELL AVE
Mailing Address - Street 2:#2
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4316
Mailing Address - Country:US
Mailing Address - Phone:612-790-1259
Mailing Address - Fax:
Practice Address - Street 1:3445 BLAISDELL AVE
Practice Address - Street 2:#2
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4316
Practice Address - Country:US
Practice Address - Phone:612-790-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist