Provider Demographics
NPI:1629413646
Name:RAADT, KRISTINE MICHELE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MICHELE
Last Name:RAADT
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 1:855 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4868
Mailing Address - Country:US
Mailing Address - Phone:507-474-3184
Mailing Address - Fax:507-453-3791
Practice Address - Street 1:109 W JESSE ST
Practice Address - Street 2:RUSHFORD CLINIC
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971
Practice Address - Country:US
Practice Address - Phone:507-864-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist