Provider Demographics
NPI:1114940566
Name:KAMMERER, JANNEL PAULINE (MPT)
Entity Type:Individual
Prefix:
First Name:JANNEL
Middle Name:PAULINE
Last Name:KAMMERER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 8TH AVE N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7662
Mailing Address - Country:US
Mailing Address - Phone:952-933-5085
Mailing Address - Fax:952-931-2159
Practice Address - Street 1:15 8TH AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7662
Practice Address - Country:US
Practice Address - Phone:952-933-5085
Practice Address - Fax:952-931-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001045Medicare ID - Type UnspecifiedPHYSICAL THERAPIST