Healthcare Provider Details

I. General information

NPI: 1922562883
Provider Name (Legal Business Name): KINECIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 CURRELL BLVD STE 325
WOODBURY MN
55125-2257
US

IV. Provider business mailing address

7650 CURRELL BLVD STE 325
WOODBURY MN
55125-2257
US

V. Phone/Fax

Practice location:
  • Phone: 715-410-0351
  • Fax:
Mailing address:
  • Phone: 715-410-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BRIAN LEONARD WEBER
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 715-410-0351