Healthcare Provider Details

I. General information

NPI: 1942344478
Provider Name (Legal Business Name): KRISTIN NOEL PROCOPIO MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 W LAKE ST #225
MINNEAPOLIS MN
55408-2554
US

IV. Provider business mailing address

1516 W LAKE ST #225
MINNEAPOLIS MN
55408-2554
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-2012
  • Fax: 952-922-2013
Mailing address:
  • Phone: 952-922-2012
  • Fax: 952-922-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: