Healthcare Provider Details

I. General information

NPI: 1285362509
Provider Name (Legal Business Name): ANDREW KEZAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HIGHWAY 15 S
HUTCHINSON MN
55350-5000
US

IV. Provider business mailing address

1095 HIGHWAY 15 S
HUTCHINSON MN
55350-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-234-3290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12815
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: