Healthcare Provider Details

I. General information

NPI: 1508130147
Provider Name (Legal Business Name): PATTI KAMPA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NE 5TH ST
GRAND RAPIDS MN
55744-2760
US

IV. Provider business mailing address

28651 SUNNY BEACH RD
GRAND RAPIDS MN
55744-4558
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-2200
  • Fax: 218-326-2977
Mailing address:
  • Phone: 218-326-2200
  • Fax: 218-326-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2710
License Number StateMN

VIII. Authorized Official

Name: PATRICIA J KAMPA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 218-326-2200