Provider Demographics
NPI:1982024808
Name:ROREM, KELLI MARIE (PT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MARIE
Last Name:ROREM
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:MARIE
Other - Last Name:BUERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:7581 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6635
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:
Practice Address - Street 1:600 MARKET ST STE 150
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4570
Practice Address - Country:US
Practice Address - Phone:952-491-4700
Practice Address - Fax:952-491-4701
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25012255A2300X
MN10284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer