Lara O Stanislaw, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8906 Issued in MN

Practice address

2151 Hamline Ave N
Suite #111
Roseville, MN 55113-4236

Phone

(651) 636-5560

NPI assigned

Jul 13, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373673600000",
    "number": "1457792855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 PORTLAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551045853",
            "telephone_number": "651-402-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 HAMLINE AVE N",
            "address_2": "SUITE #111",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134236",
            "telephone_number": "651-636-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANISLAW",
        "first_name": "LARA",
        "middle_name": "O",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-13",
        "last_updated": "2013-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Roseville, MN
• Providers in Roseville, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.