Provider Demographics
NPI:1942842190
Name:KIRCHOFF-KNAPP, REBECCA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:KIRCHOFF-KNAPP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOONE AVE N STE 135
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4476
Mailing Address - Country:US
Mailing Address - Phone:612-327-1146
Mailing Address - Fax:
Practice Address - Street 1:800 BOONE AVE N STE 135
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4476
Practice Address - Country:US
Practice Address - Phone:612-327-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2047208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation