Healthcare Provider Details

I. General information

NPI: 1962316083
Provider Name (Legal Business Name): KRISTEN DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 KELLEY PKWY
ORONO MN
55356-4556
US

IV. Provider business mailing address

3104 MAGNOLIA DR
MEDINA MN
55340-9015
US

V. Phone/Fax

Practice location:
  • Phone: 952-200-0585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: