Provider Demographics
NPI:1063775807
Name:RADACH, LAUREN (CMT)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:RADACH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SINGLETREE LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5328
Mailing Address - Country:US
Mailing Address - Phone:952-949-0676
Mailing Address - Fax:952-949-0868
Practice Address - Street 1:11800 SINGLETREE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5328
Practice Address - Country:US
Practice Address - Phone:952-949-0676
Practice Address - Fax:952-949-0868
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist