Kjersten Rae Grinde, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10046 Issued in MN

Practice address

3801 Hart Boulevard
Colombia Heights, MN 55421-4106

Phone

(763) 210-6697

Fax

(763) 210-6698

NPI assigned

Aug 9, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Primary Therapy Source, LLC

  • Physical Therapist
  • Twin Falls, ID
  • NPI 1912027343
  Medicare reassignment NPD
• Primary Therapy Source LLC

  • Durable Medical Equipment & Medical Supplies
  • Twin Falls, ID
  • NPI 1104672682

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439078400000",
    "number": "1235515594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 HART BOULEVARD",
            "city": "COLOMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554214106",
            "telephone_number": "763-210-6697",
            "fax_number": "763-210-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 HART BOULEVARD",
            "city": "COLOMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554214106",
            "telephone_number": "763-210-6697",
            "fax_number": "763-210-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRINDE",
        "first_name": "KJERSTEN",
        "middle_name": "RAE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-09",
        "last_updated": "2015-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.