Provider Demographics
NPI:1942344478
Name:PROCOPIO, KRISTIN NOEL (MPT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:NOEL
Last Name:PROCOPIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W LAKE ST
Mailing Address - Street 2:#225
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2554
Mailing Address - Country:US
Mailing Address - Phone:952-922-2012
Mailing Address - Fax:952-922-2013
Practice Address - Street 1:1516 W LAKE ST
Practice Address - Street 2:#225
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2554
Practice Address - Country:US
Practice Address - Phone:952-922-2012
Practice Address - Fax:952-922-2013
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN237761048937OtherPREFERRED ONE
MNHP73743OtherHEALTH PARTNERS
MN528L5PROtherBCBS