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Organization
PRESCOTT THERAPIES LLC
Active
Organization
PRESCOTT THERAPIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS JOHN KIERSTEAD PT (MANAGING MEMBER)
(952) 807-7312
Entity
Organization
Contact information
Practice address
825 NICOLLET MALL STE 1947, MINNEAPOLIS, MN 55402-2707
(952) 200-0215
(833) 499-1896
Mailing address
18872 42ND AVE N, PLYMOUTH, MN 55446-3068
(952) 807-7312
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/12/2020
Last updated
11/20/2024
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