Provider Demographics
NPI:1427146737
Name:KINESIS PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:KINESIS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:320-654-9838
Mailing Address - Street 1:1521 NORTHWAY DR
Mailing Address - Street 2:SUITE #116
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4489
Mailing Address - Country:US
Mailing Address - Phone:320-654-9838
Mailing Address - Fax:320-654-0981
Practice Address - Street 1:1521 NORTHWAY DR
Practice Address - Street 2:SUITE #116
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4489
Practice Address - Country:US
Practice Address - Phone:320-654-9838
Practice Address - Fax:320-654-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47777KIOtherBLUE CROSS BLUE SHIELD
MN81908OtherHEALTH PARTNERS
MN117577700Medicaid
MN=========OtherTRICARE
MN=========OtherUCARE
MN=========OtherHUMANA
MN117577700Medicaid