Provider Demographics
NPI:1316647282
Name:GRELL, KAITLYN MARIE I (LPTA)
Entity type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MARIE
Last Name:GRELL
Suffix:I
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50125 ACACIA LN
Mailing Address - Street 2:
Mailing Address - City:STANCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55080-5176
Mailing Address - Country:US
Mailing Address - Phone:612-987-9158
Mailing Address - Fax:
Practice Address - Street 1:650 S BREMER AVE
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069-9096
Practice Address - Country:US
Practice Address - Phone:320-358-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A1975225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant