Provider Demographics
NPI:1548566052
Name:KROGSTAD, KIMBERLY K (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:KROGSTAD
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 1:1205 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-2574
Mailing Address - Country:US
Mailing Address - Phone:320-333-7195
Mailing Address - Fax:
Practice Address - Street 1:1205 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-2574
Practice Address - Country:US
Practice Address - Phone:320-333-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist