Provider Demographics
NPI:1356484059
Name:KITTELSON, BRIAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:KITTELSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S PLATEAU TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-1936
Mailing Address - Country:US
Mailing Address - Phone:605-362-0779
Mailing Address - Fax:
Practice Address - Street 1:8701 W. 32ND ST.
Practice Address - Street 2:ROOM 108
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106
Practice Address - Country:US
Practice Address - Phone:605-323-6990
Practice Address - Fax:605-323-6991
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist