Healthcare Provider Details

I. General information

NPI: 1194307207
Provider Name (Legal Business Name): KEVIN LOUIS SCHIMEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 NICOLLET CT STE 335
BURNSVILLE MN
55306-8330
US

IV. Provider business mailing address

14300 NICOLLET CT STE 335
BURNSVILLE MN
55306-8330
US

V. Phone/Fax

Practice location:
  • Phone: 952-851-6000
  • Fax:
Mailing address:
  • Phone: 952-851-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA487
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: