1023202835 NPI number — JANICE PATRICIA KEHLER PT MSC MA

Table of content: JANICE PATRICIA KEHLER PT MSC MA (NPI 1023202835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023202835 NPI number — JANICE PATRICIA KEHLER PT MSC MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEHLER
Provider First Name:
JANICE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT MSC MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COYSTON
Provider Other First Name:
JANICE
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023202835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3915 GOLDEN VALLEY RD
Provider Second Line Business Mailing Address:
COURAGE CENTER
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-4249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-588-0811
Provider Business Mailing Address Fax Number:
763-520-0355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 GOLDEN VALLEY RD
Provider Second Line Business Practice Location Address:
COURAGE CENTER
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-4249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-588-0811
Provider Business Practice Location Address Fax Number:
763-520-0355
Provider Enumeration Date:
09/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4804 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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