Individual provider Active NPI

Kristine Zeznick Trimble, PT, DPT

  • Physical Therapist
  • Coon Rapids, MN
National Provider Identifier
1962512418
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8698 Issued in MN
Practice address
2104 Northdale Blvd NW Ste 100
Coon Rapids, MN 55433-3045
Phone
(763) 755-5495
Fax
(763) 862-0342
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X 8698 MN Primary

Addresses

Primary practice location

2104 Northdale Blvd NW Ste 100
Coon Rapids, MN 55433-3045

Mailing address

2104 Northdale Blvd NW Ste 100
Coon Rapids, MN 55433-3045
Phone (763) 755-5495

Other identifiers 1

IdentifierTypeStateIssuer
8698OtherMNMN STATE BOARD OF PT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120404000908 MN Practitioner - Physical Therapist in Private Practice 1456511138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, 493 clinicians

Practice addresses (Care Compare)

10091 Dogwood St NW
Coon Rapids, MN 55448-5273
Phone (763) 450-0298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8698MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Novacare Outpatient Rehabilitation East Inc CurrentSince May 3, 2023 Accepting new patients
Novacare Outpatient Rehabilitation East Inc Physical Therapist CurrentSince May 3, 2023 Accepting new patients
Novacare Outpatient Rehabilitation East Inc Physical Therapist Current Accepting new patients
Advanced Spine Associates PA Physical Therapist Past Accepting new patients
Physical Therapy Consultants, Inc. Past Accepting new patients

Locations

2104 Northdale Blvd NW
Ste 100
Minneapolis, MN 55433
Phone (763) 755-5495

10091 Dogwood St NW
Minneapolis, MN 55448
Phone (763) 450-0298

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1962512418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW STE 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333045",
            "telephone_number": "763-755-5495",
            "fax_number": "763-862-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW STE 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333045",
            "telephone_number": "763-755-5495",
            "fax_number": "763-862-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIMBLE",
        "first_name": "KRISTINE",
        "middle_name": "ZEZNICK",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN STATE BOARD OF PT",
            "identifier": "8698",
            "state": "MN"
        }
    ],
    "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 Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.