=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518824424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLIE VANNYHUIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12756 MOUND RD SE
-----------------------------------------------------
City | OSAKIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56360-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-815-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12756 MOUND RD SE
-----------------------------------------------------
City | OSAKIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56360-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-815-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A647
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------