Provider Demographics
NPI:1427867613
Name:MACHOVEC, KAITLIN N
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:N
Last Name:MACHOVEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3583 156TH ST W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1542
Mailing Address - Country:US
Mailing Address - Phone:651-230-6311
Mailing Address - Fax:
Practice Address - Street 1:901 DAVIDSON ST NW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9015
Practice Address - Country:US
Practice Address - Phone:563-245-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123686225100000X
NMPT-2025-001225100000X
MN13289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist