Provider Demographics
NPI:1487785044
Name:KINETIC PHYSICAL THERAPY INSTITUTE
Entity type:Organization
Organization Name:KINETIC PHYSICAL THERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, ATR, PRC
Authorized Official - Phone:651-730-7771
Mailing Address - Street 1:731 BIELENBERG DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1700
Mailing Address - Country:US
Mailing Address - Phone:651-730-7771
Mailing Address - Fax:651-730-7772
Practice Address - Street 1:731 BIELENBERG DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1700
Practice Address - Country:US
Practice Address - Phone:651-730-7771
Practice Address - Fax:651-730-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04115Medicare ID - Type Unspecified