Provider Demographics
NPI:1205029493
Name:HENDRICKSON, KAYSIE (DPT)
Entity Type:Individual
Prefix:
First Name:KAYSIE
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W 78TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2560
Mailing Address - Country:US
Mailing Address - Phone:952-914-8065
Mailing Address - Fax:952-914-8066
Practice Address - Street 1:8100 W 78TH ST STE 205
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2560
Practice Address - Country:US
Practice Address - Phone:952-914-8065
Practice Address - Fax:952-914-8066
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03152Medicare PIN