Healthcare Provider Details

I. General information

NPI: 1275960338
Provider Name (Legal Business Name): KRISTIN FRANCES KUTCH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN FRANCES DEFENBAUGH ATC

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COUNTY ROAD 101
MINNETONKA MN
55345
US

IV. Provider business mailing address

15335 FOLIAGE AVE
APPLE VALLEY MN
55124
US

V. Phone/Fax

Practice location:
  • Phone: 952-512-2400
  • Fax:
Mailing address:
  • Phone: 815-985-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2473
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: