MEDICARE: KATELYN DARNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11366	MN

General Provider Information

NPI Number	:	1164057642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN DARNELL

Provider Business Mailing Address
First Line	:	2600 39TH AVE NE STE 220
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-5052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 39TH AVE NE STE 220
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-5052
Country	:	US
Telephone Number	:	612-672-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/09/2020

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Directions to “ KATELYN DARNELL ” Practice Location

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