Provider Demographics
NPI:1558098350
Name:CHAMBERLIN, KIRSTEN ANN
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANN
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1633
Mailing Address - Country:US
Mailing Address - Phone:218-451-0445
Mailing Address - Fax:
Practice Address - Street 1:8100 HIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1006
Practice Address - Country:US
Practice Address - Phone:952-831-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12277208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12277OtherMN BOARD OF PHYSICAL THERAPY