Healthcare Provider Details

I. General information

NPI: 1679321384
Provider Name (Legal Business Name): KAITLYN KNISLEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN FROEMKE PT

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TOWER DR W
STILLWATER MN
55082-7529
US

IV. Provider business mailing address

1939 MINNEHAHA AVE W STE 300
SAINT PAUL MN
55104-1033
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-4706
  • Fax: 651-439-7173
Mailing address:
  • Phone: 651-748-4338
  • Fax: 651-748-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16843-24
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13584
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: