Provider Demographics
NPI:1265493977
Name:COYLE, KRYSTAN A (DPT, MBA, OCS)
Entity Type:Individual
Prefix:
First Name:KRYSTAN
Middle Name:A
Last Name:COYLE
Suffix:
Gender:F
Credentials:DPT, MBA, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 VIKINGS CIR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1000
Mailing Address - Country:US
Mailing Address - Phone:952-456-7600
Mailing Address - Fax:952-456-7601
Practice Address - Street 1:2645 VIKINGS CIR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:952-456-7600
Practice Address - Fax:952-456-7601
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6882225100000X, 225100000X
KY33042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
0797106Medicare ID - Type Unspecified