Active NPI
Travis Kierstead
- Physical Therapist
- Plymouth, MN
National Provider Identifier
1295022671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8879
- Practice address
- 18872 42ND Ave N
Plymouth, MN 55446-3068 - Phone
- (952) 807-7312
- Fax
- (833) 499-1896
- NPI assigned
- Jul 6, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8879 | MN | Primary |
Addresses
Primary practice location
18872 42ND Ave N
Plymouth, MN 55446-3068
Mailing address
18872 42ND Ave N
Plymouth, MN 55446-3068
Phone (952) 807-7312
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8879 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1295022671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18872 42ND AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554463068",
"telephone_number": "952-807-7312",
"fax_number": "833-499-1896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18872 42ND AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554463068",
"telephone_number": "952-807-7312",
"fax_number": "833-499-1896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIERSTEAD",
"first_name": "TRAVIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-06",
"last_updated": "2021-01-18",
"certification_date": "2021-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "8879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.