Provider Demographics
NPI:1912571845
Name:FUNCTIONAL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FUNCTIONAL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICALTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:763-227-5298
Mailing Address - Street 1:540 W HORIZON RIDGE PKWY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5241
Mailing Address - Country:US
Mailing Address - Phone:763-227-5298
Mailing Address - Fax:
Practice Address - Street 1:540 W HORIZON RIDGE PKWY UNIT 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5241
Practice Address - Country:US
Practice Address - Phone:763-227-5298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty