Provider Demographics
NPI:1275960338
Name:KUTCH, KRISTIN FRANCES (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:FRANCES
Last Name:KUTCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:FRANCES
Other - Last Name:DEFENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:15335 FOLIAGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:815-985-6421
Mailing Address - Fax:
Practice Address - Street 1:5101 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-512-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer