Provider Demographics
NPI:1639152135
Name:BECKER, KIRSTEN (PT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W SAINT GERMAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4743
Mailing Address - Country:US
Mailing Address - Phone:320-259-4151
Mailing Address - Fax:320-259-5707
Practice Address - Street 1:2835 W SAINT GERMAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4743
Practice Address - Country:US
Practice Address - Phone:320-259-4151
Practice Address - Fax:320-259-5707
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN5809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150073OtherMAYO MANAGEMENT ID
MN6401299OtherMEDICA PROVIDER ID
MN41163580956301B013OtherCHAMPUS
MN9B104BEOtherBCBS PROVIDER ID
MNHP31758OtherHEALTHPARTNERS ID