Provider Demographics
NPI:1669616736
Name:ROBERTS, KAY W (PT)
Entity type:Individual
Prefix:MR
First Name:KAY
Middle Name:W
Last Name:ROBERTS
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21111
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-0111
Mailing Address - Country:US
Mailing Address - Phone:651-905-3783
Mailing Address - Fax:651-905-3783
Practice Address - Street 1:3017 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1715
Practice Address - Country:US
Practice Address - Phone:612-721-7981
Practice Address - Fax:612-721-7981
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6424186OtherMEDICA
MN241545300Medicaid
6424186OtherMEDICA