Active NPI
Kevin Robert Gennrich, DPT
- Physical Therapist
- Eden Prairie, MN
National Provider Identifier
1982834016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8630
- Practice address
- 12982 Valley View Rd
Eden Prairie, MN 55344-3657 - Phone
- (952) 924-2519
- Fax
- (952) 924-0092
- NPI assigned
- Jul 23, 2009
- 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 | 8630 | MN | Primary |
Addresses
Primary practice location
12982 Valley View Rd
Eden Prairie, MN 55344-3657
Mailing address
4200 Dahlberg Dr
Suite 300
Golden Valley, MN 55422-4840
Phone (952) 512-5600
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 |
|---|---|---|---|
| 8630 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Infinite Health Collaborative, PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- River Falls, WI
- NPI 1144608589
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1982834016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 DAHLBERG DR",
"address_2": "SUITE 300",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224840",
"telephone_number": "952-512-5600",
"fax_number": "952-512-5637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12982 VALLEY VIEW RD",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443657",
"telephone_number": "952-924-2519",
"fax_number": "952-924-0092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENNRICH",
"first_name": "KEVIN",
"middle_name": "ROBERT",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-23",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "8630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.