Provider Demographics
NPI:1316107220
Name:LAHTI, DUANE J JR (DPT, CMTPT)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:J
Last Name:LAHTI
Suffix:JR
Gender:M
Credentials:DPT, CMTPT
Other - Prefix:
Other - First Name:DJ
Other - Middle Name:
Other - Last Name:LAHTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7581 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6635
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:4135 RICHARD AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-206-7775
Practice Address - Fax:218-206-7776
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11047-024225100000X
MN9582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36170600Medicaid
WI36170600Medicaid