Provider Demographics
NPI:1497868095
Name:STOKES, KELLY SUE (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:STOKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:SUE
Other - Last Name:RUNNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1308 DEERCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15075 CIMARRON AVE
Practice Address - Street 2:#20
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1635
Practice Address - Country:US
Practice Address - Phone:651-322-8888
Practice Address - Fax:651-322-8889
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist