Individual
KIMBERLY KAY CEROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
Mailing address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
852A
ND
225200000X
Physical Therapy Assistant
A276
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
852A
PTA LICENSE
ND
01
—
A276
PTA LICENSE
MN
Enumeration date
12/12/2019
Last updated
12/12/2019
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