Provider Demographics
NPI:1275045692
Name:PAULSON, KRISTAL KAY (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:KAY
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SE BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-3265
Mailing Address - Country:US
Mailing Address - Phone:507-668-2900
Mailing Address - Fax:
Practice Address - Street 1:1705 SE BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-3265
Practice Address - Country:US
Practice Address - Phone:507-668-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist