Provider Demographics
NPI:1063673580
Name:OLTMAN, KERRIJO FRANCES (DPT)
Entity Type:Individual
Prefix:
First Name:KERRIJO
Middle Name:FRANCES
Last Name:OLTMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KERRIJO
Other - Middle Name:FRANCES
Other - Last Name:CARNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7250 FRANCE AVE S STE 111
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4311
Mailing Address - Country:US
Mailing Address - Phone:952-831-8991
Mailing Address - Fax:
Practice Address - Street 1:7250 FRANCE AVE S STE 111
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4311
Practice Address - Country:US
Practice Address - Phone:952-831-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT9325225100000X
MNPT 8488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00626892OtherRAILROAD MEDICARE
GA511I650199Medicare PIN