Provider Demographics
NPI:1164205621
Name:PALKERT, KIMBERLY NAN (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NAN
Last Name:PALKERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NAN
Other - Last Name:LIDSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:14884 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8451
Mailing Address - Country:US
Mailing Address - Phone:218-824-5027
Mailing Address - Fax:218-824-8011
Practice Address - Street 1:14884 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8451
Practice Address - Country:US
Practice Address - Phone:218-824-5027
Practice Address - Fax:218-824-8011
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist