Healthcare Provider Details

I. General information

NPI: 1306893177
Provider Name (Legal Business Name): BRENDA PEITZ KNAEBLE P.T., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14181 BUSINESS CENTER DR NW
ELK RIVER MN
55330-4654
US

IV. Provider business mailing address

425 CRESCENT ST
BIG LAKE MN
55309-9493
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-0407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4570
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4570
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: