Functional Kids Clinic

LBN: Functional Integrated Therapy, Ltd
Functional Kids Clinic is an health care organization with primary practice located at 2495 Maplewood Drive Suite 313, Maplewood MN 55109-1913. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rehabilitation, which is considered as the primary health care specialty. Functional Integrated Therapy, Ltd can be contacted via phone (651) 770-8884, or through Worrell, Kristi Kay via phone (651) 770-8884.

Contact Information

Primary practice address
2495 Maplewood Drive Suite 313 Maplewood MN 55109-1913
Phone: (651) 770-8884
Fax: (651) 770-8151
Website:
Map and Directions
Authorized official contact:
Name: Worrell, Kristi Kay OTR/L
Phone: (651) 770-8884

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rehabilitation 261QR0400X 100591 Minnesota

Profile Details

NPI number 1477640613
LBN Legal business name Functional Integrated Therapy, Ltd
DBA Doing business as Functional Kids Clinic
Authorized official Worrell, Kristi Kay OTR/L
Entity Organization
Organization subpart 1 No
Enumeration date Oct 9th, 2006
Last updated Mar 31st, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477640613 NPPES
Minnesota Other 0007336046 AETNA
Minnesota Other 133343 AETNA
Minnesota Other 28D39FU AETNA
Minnesota Other 6401782 AETNA
Minnesota MEDICAID 670043800 AETNA
Minnesota Other J053 AETNA
Minnesota Other 18905 AETNA
Minnesota Other 181389 AETNA
Minnesota Other 36655 AETNA
Minnesota Other 75732 AETNA

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