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Organization

KINESIS PHYSICAL THERAPY, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS M PETERSON P.T. (OWNER/PHYSICAL THERAPIST)
(320) 654-9838
Entity
Organization

Contact information

Practice address
1521 NORTHWAY DR, SUITE #116, SAINT CLOUD, MN 56303-4489
(320) 654-9838
(320) 654-0981
Mailing address
1521 NORTHWAY DR, SUITE #116, SAINT CLOUD, MN 56303-4489
(320) 654-9838
(320) 654-0981

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
117577700
MN
01
47777KI
BLUE CROSS BLUE SHIELD
MN
01
81908
HEALTH PARTNERS
MN
Enumeration date
10/11/2006
Last updated
05/31/2022
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