Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2787 | MN |
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1225174683 |
---|---|
Provider Name | Kim Alan Anderson |
First Address | Minneapolis, MN 55405-2125 |
Second Address | Minneapolis, MN 55405-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 19/03/2020 |