Provider Demographics
NPI:1336451228
Name:PAULSON, KRISTIN IRENE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:IRENE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:IRENE
Other - Last Name:SORENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 450
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-836-3820
Mailing Address - Fax:952-836-3821
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 450
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-836-3820
Practice Address - Fax:952-836-3821
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist