=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841153012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY KNUTSON DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 W BROADWAY AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55411-2533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-668-5100
-----------------------------------------------------
Fax | 612-668-5110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3320 ELLIOT AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55407-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-517-5834
-----------------------------------------------------
Fax | 612-668-5110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6587
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------