Healthcare Provider Details

I. General information

NPI: 1821343435
Provider Name (Legal Business Name): BENJAMIN WILLIAM KORRER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 GROVE CIR N
MAPLE GROVE MN
55369-4475
US

IV. Provider business mailing address

8170 33RD AVE S MAILSTOP 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5900
  • Fax:
Mailing address:
  • Phone: 952-883-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12028
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9537
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: