Kelsey A Diederich, PT
Individual provider Active NPI Physical Therapist · St Cloud, MN
NPI 1477092971 · NPPES record last updated Jul 6, 2018
Key facts
- NPI
- 1477092971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9786 (MN)
- Practice address
- St Cloud Hospital
1406 6TH Avenue North
St Cloud, MN 56303-1901 - Phone
- (320) 251-2700
- Fax
- (320) 656-7115
- NPI assigned
- Feb 16, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
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
- St Cloud Hospital
Practice addresses (Care Compare)
110 2ND St S
Suite 104
Waite Park, MN 56387-1367
Phone (320) 259-9375
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700
1900 Centracare Cir
Suite 2400
Saint Cloud, MN 56303-5000
Phone (320) 252-2422
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181030000072 | MN | Practitioner - Physical Therapist in Private Practice | 8729331335 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Cloud Hospital | Current |
Accepting new patients | |
| St. Cloud Hospital | Current | Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Centracare Clinic | Current | Accepting new patients |
Locations
1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9786 | MN | Yes |
Addresses
Primary practice location
St Cloud Hospital
1406 6TH Avenue North
St Cloud, MN 56303-1901
Mailing address
St Cloud Hospital
1406 6TH Avenue North
St Cloud, MN 56303-1901
Phone (320) 251-2700
Other providers in St Cloud, MN
- Developmental Impact LLC
- Sara Devos
- Sara Dezell
- Gati Niranjan Dhroove
- Heather Diaz
- Leah Diederich
- Samantha Dietman
- Tabitha Paige Dietz
- Dima Transportation LLC
- Lindsay J Dingman
All providers in St Cloud, 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 Jul 6, 2018. 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.