Soukup, Kelly J

Soukup, Kelly J is an individual health care provider with primary practice located at 1000 W 140Th St Suite 202, Burnsville MN 55337-4480. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Soukup, Kelly J can be contacted via phone (952) 808-3052.

Contact Information

Primary practice address
1000 W 140Th St Suite 202 Burnsville MN 55337-4480
Phone: (952) 808-3052
Fax: (952) 846-2202
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 7269 Minnesota

Profile Details

NPI number 1669419610
LBN Legal business name Soukup, Kelly J
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2006
Last updated Apr 20th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669419610 NPPES
Minnesota Other 210K0SO BLUECROSS BLUESHEILD
Minnesota MEDICAID 011698000 BLUECROSS BLUESHEILD
Minnesota Other 6404216 BLUECROSS BLUESHEILD
Minnesota Other HP39430 BLUECROSS BLUESHEILD

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