Provider Demographics
NPI:1639334618
Name:SPAHR, KEVIN ROBERT (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:SPAHR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 124TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2690
Mailing Address - Country:US
Mailing Address - Phone:507-313-3831
Mailing Address - Fax:
Practice Address - Street 1:125 SE MAIN ST
Practice Address - Street 2:SUITE #237
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2143
Practice Address - Country:US
Practice Address - Phone:612-767-9917
Practice Address - Fax:612-767-9918
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist