Healthcare Provider Details

I. General information

NPI: 1700718046
Provider Name (Legal Business Name): LYDIA PERLE KAEGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PRAIRIE CENTER DR # 440
EDEN PRAIRIE MN
55344-7314
US

IV. Provider business mailing address

775 PRAIRIE CENTER DR # 440
EDEN PRAIRIE MN
55344-7314
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-5640
  • Fax:
Mailing address:
  • Phone: 952-428-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: