Active NPI
Kaylee Lyn Gombold
- Physical Therapist
- Coon Rapids, MN
National Provider Identifier
1912411406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10955
- Practice address
- 4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522 - Phone
- (763) 236-6000
- NPI assigned
- Nov 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 | 10955 | MN | Primary |
Addresses
Primary practice location
4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Mailing address
11771 56TH St N
Lake Elmo, MN 55042-6100
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10955 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1912411406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11771 56TH ST N",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550426100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4050 COON RAPIDS BLVD NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554332522",
"telephone_number": "763-236-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMBOLD",
"first_name": "KAYLEE",
"middle_name": "LYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-20",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "10955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.