Provider Demographics
NPI:1962041269
Name:BRZINSKI, KAYLI MARIE (CMT)
Entity Type:Individual
Prefix:MISS
First Name:KAYLI
Middle Name:MARIE
Last Name:BRZINSKI
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MISS
Other - First Name:ECKO
Other - Middle Name:MARIE
Other - Last Name:BRZINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:700 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387
Mailing Address - Country:US
Mailing Address - Phone:320-282-9551
Mailing Address - Fax:
Practice Address - Street 1:700 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387
Practice Address - Country:US
Practice Address - Phone:320-282-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist