Provider Demographics
NPI:1396766226
Name:TRELSTAD, LAVAUN MARILYN (PT)
Entity type:Individual
Prefix:
First Name:LAVAUN
Middle Name:MARILYN
Last Name:TRELSTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2109
Mailing Address - Country:US
Mailing Address - Phone:952-920-8088
Mailing Address - Fax:763-302-4219
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-920-8088
Practice Address - Fax:763-302-4219
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10A54TROtherBCBS OF MN
MN24381OtherAMERICA'S PPO
MN962871010735OtherPREFERRED ONE
MNHP44377OtherHEALTHPARTNERS
MN6429730OtherMEDICA