Kimberly Anne Gustafson | Maple Grove, MN • PECOS Search

Kimberly Anne Gustafson

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

12000 Elm Creek Blvd N, Suite #120, Maple Grove, MN 55369-7073

(763) 420-9960 (612) 990-0714

PECOS Enrollment

Based on the most recent information from CMS, provider Kimberly Anne Gustafson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1629410618
Provider Type
Individual
Full Name
Gustafson, Kimberly Anne
Title
Miss
Credential
PT, DPT

Gender
Female
Sole Proprietor
No
Enumeration Date
7/19/2013
Last Updated
4/8/2015

Contact Information

Practice Location

12000 Elm Creek Blvd N, Suite #120, Maple Grove, MN 55369-7073

Unlisted Fax

Mailing Location

7616 30th Ave N, Crystal, MN 55427-2702

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 9409 Minnesota