Organization
MINNETONKA PEDIATRIC THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAYE M BAUMGARDNER MS. CCC-SLP/COM (OWNER/SPEECH PATHOLOGIST)
(763) 595-0812
Entity
Organization
Contact information
Practice address
15600 36TH AVE N STE 120, PLYMOUTH, MN 55446-3687
(763) 595-0812
(763) 595-0824
Mailing address
15600 36TH AVE N STE 120, PLYMOUTH, MN 55446-3687
(763) 595-0812
(763) 595-0824
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
MN
225X00000X
Occupational Therapist
—
MN
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
MN
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323915000
—
MN
Enumeration date
06/06/2007
Last updated
01/29/2021
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