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NPI Code Detail

MEDICARE: KELLY CHRISTINE SANBORN PT, DPT

MEDICARE: KELLY CHRISTINE SANBORN PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist004900IA

General Provider Information

NPI Number : 1033482526
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY CHRISTINE SANBORN PT, DPT
Provider Business Mailing Address
First Line : 703 THIELEN DR
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-9613
Country : US
Telephone Number : 763-497-1153
Fax Number : 763-497-5256
Provider Business Practice Location Address
First Line : 703 THIELEN DR
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-9613
Country : US
Telephone Number : 763-497-1153
Fax Number : 763-497-5256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2012
Last Update Date : 06/13/2013

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Directions to “ KELLY CHRISTINE SANBORN PT, DPT” Practice Location

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