Provider Demographics
NPI:1962512418
Name:TRIMBLE, KRISTINE ZEZNICK (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ZEZNICK
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 NORTHDALE BLVD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3045
Mailing Address - Country:US
Mailing Address - Phone:763-755-5495
Mailing Address - Fax:763-862-0342
Practice Address - Street 1:2104 NORTHDALE BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3045
Practice Address - Country:US
Practice Address - Phone:763-755-5495
Practice Address - Fax:763-862-0342
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MN8698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8698OtherMN STATE BOARD OF PT
VA2305203199OtherLICENSE #