Provider Demographics
NPI:1811038797
Name:RAKERS, KIIRSTEN (BS)
Entity Type:Individual
Prefix:
First Name:KIIRSTEN
Middle Name:
Last Name:RAKERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1802
Mailing Address - Country:US
Mailing Address - Phone:952-492-8470
Mailing Address - Fax:952-492-3880
Practice Address - Street 1:100 HOPE AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1802
Practice Address - Country:US
Practice Address - Phone:952-492-8470
Practice Address - Fax:952-492-3880
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist