Healthcare Provider Details

I. General information

NPI: 1629395744
Provider Name (Legal Business Name): JONAS KYLLONEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 HIGHWAY 110 WHITE COMMUNITY HOSPITAL
AURORA MN
55705-1522
US

IV. Provider business mailing address

5211 HIGHWAY 110 WHITE COMMUNITY HOSPITAL
AURORA MN
55705-1522
US

V. Phone/Fax

Practice location:
  • Phone: 218-229-3311
  • Fax:
Mailing address:
  • Phone: 218-229-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7596
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: