=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487785044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINETIC PHYSICAL THERAPY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 04/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 BIELENBERG DR SUITE 107
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-730-7771
-----------------------------------------------------
Fax | 651-730-7772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 731 BIELENBERG DR SUITE 107
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-730-7771
-----------------------------------------------------
Fax | 651-730-7772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | CARRIE LANGER
-----------------------------------------------------
Credential | MPT, ATR, PRC
-----------------------------------------------------
Telephone | 651-730-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------