Provider Demographics
NPI:1619717709
Name:LAKMANN, MIRANDA LEE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEE
Last Name:LAKMANN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEE
Other - Last Name:OVERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 VICTORIA ST S APT B236
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4271
Mailing Address - Country:US
Mailing Address - Phone:612-990-0251
Mailing Address - Fax:
Practice Address - Street 1:2525 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3205
Practice Address - Country:US
Practice Address - Phone:612-672-6697
Practice Address - Fax:612-672-6816
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist