Kelly Kitzman, PT
Individual provider Active NPI Physical Therapist · Faribault, MN
NPI 1184465403 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1184465403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9698 (MN)
- Practice address
- 1520 17TH St NW
Faribault, MN 55021-2817 - Phone
- (218) 205-0190
- NPI assigned
- Jun 3, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 26
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aegis Group Practice LLC
Practice addresses (Care Compare)
1520 17TH St NW
Faribault, MN 55021-2817
Phone (800) 444-6845
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240813001806 | MN | Practitioner - Physical Therapist in Private Practice | 7416495114 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9698 | MN | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Physical Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Physical Therapist | Current |
Accepting new patients |
| Aegis Group Practice LLC | Physical Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9698 | MN | Yes |
Addresses
Primary practice location
1520 17TH St NW
Faribault, MN 55021-2817
Mailing address
1520 17TH St NW
Faribault, MN 55021-2817
Other providers in Faribault, MN
- Erin Michelle Kelly
- Keystone Communities of Faribault
- Ashley Kimmell
- King Orthodontics LTD
- Darrin Lee King
- Steven James Klapmeier
- Jennifer E Klein
- Stacey Leigh Klempnauer
- Kelly Knaeble
- Stephanie Knowles
All providers in Faribault, MN · Physical Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.