=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851098503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN ALBERT KLEIN PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2023
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3580 ARCADE ST
-----------------------------------------------------
City | VADNAIS HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55127-7135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-968-5201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 UNIVERSITY AVE SE UNIT 1402
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55414-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-651-2744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 12956
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------