Individual
KENNETH OMUNDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
135 FERN ST N, CAMBRIDGE, MN 55008-1033
(763) 689-5385
Mailing address
11139 264TH ST, SAINT CLOUD, MN 56301-9411
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2319
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
483T6OM
BCBS
MN
01
—
6404903
MEDICA
MN
01
—
HP49619
HEALTH PARTNERS
MN
Enumeration date
09/29/2006
Last updated
07/09/2007
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