MR. KELLY J SOUKUP (NPI# 1669419610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669419610 |
| Entity Type | Individual |
| Full Name | MR. KELLY J SOUKUP |
| Credential | PT |
| Practice Address |
1000 W 140th St Suite 202 Burnsville MN 55337-4480 |
| Mailing Address |
19052 Inman Trl Lakeville MN 55044-4701 |
| Practice Telephone | 9528083052 |
| Practice Fax Number | 9528462202 |
| Mailing Telephone | 9524696925 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-04-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 7269 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUECROSS BLUESHEILD | 210K0SO | 01 |
| MN | MEDICA | 6404216 | 01 |
| MN | HEALTHPARTNERS | HP39430 | 01 |
| MN | 011698000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891049615 | Kelly Soukup | Speech-Language Pathologist | 15675 Ambaum Blvd Sw, Highline School District, Burien, WA 98166-2523 | 2012-10-31 |
| Street Address |
1000 W 140TH ST SUITE 202 |
| City | BURNSVILLE |
| State | MN |
| Zip Code | 55337-4480 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780642082 | Geoffrey J Theobald | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2006-05-03 |
| 1689151185 | Jay Vincent Ellerbusch | Physical Therapist | 1000 W 140th St, Burnsville, MN 55337-4480 | 2018-07-26 |
| 1902359219 | Megan M Dean | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2016-08-03 |
| 1508233230 | Jennifer Lauren Smidl | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2015-08-28 |
| 1609260579 | Jason Arthur Johnson | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2015-03-27 |
| 1376931527 | Michael Allen Steiner | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-12-22 |
| 1417376856 | Alyssa Meredith Hardy | Occupational Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-04-14 |
| 1326462607 | Lindsey Jaine Anderson | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-02-07 |
| 1093142473 | Joshua John Bennington | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2013-10-01 |
| 1841626827 | Ashley Marie Meyer | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2013-09-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053939397 | Alpha Quality Care1 L. L. C. | Home Infusion | 12924 18th Ave South, Burnsville, MN 55337 | 2020-07-13 |
| 1568085900 | Kathryn Harris | Counselor | 11939 W. River Hills Dr., Burnsville, MN 55337 | 2020-05-20 |
| 1952941254 | Noah Home Care Inc. | Home Health | 13521 Nicollet Lane, Burnsville, MN 55337 | 2020-01-14 |
| 1750854287 | Baraka Home Care LLC | Nursing Care | 1700 James Place, Burnsville, MN 55337 | 2019-01-08 |
| 1699298778 | Raphael Cheron-dittmann | Hearing Instrument Specialist | 14000 Nicollet Ave. S., Suite 303, Burnsville, MN 55337 | 2017-07-20 |
| 1669909818 | Mercy Home Care Ltd | Hospice Care, Community Based | 1020 E 146th St Ste 220d, Burnsville, MN 55337 | 2017-05-18 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1730542572 | Iris Reproductive Psychiatric Clinic | Clinical Nurse Specialist | 1500 Mcandrews Road W, Ste 227, Burnsville, MN 55337 | 2016-03-30 |
| 1740657204 | Mercy Link, LLC | Home Health | 13005 Salem Pl, Burnsville, MN 55337 | 2015-08-31 |
| 1669852158 | Mixa Dipak Patel | Physical Therapy Assistant | 8380 Hiawatha Ave, Eden Prairie, MN 55337 | 2015-06-01 |
| Find all providers in zip 55337 | ||||
| Taxonomy Code | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770191819 | Robert Conrad | Physical Therapist | 4188 Highway 80 S # 10, Burnsville, NC 28714-9585 | 2020-07-15 |
| 1760901565 | William M Long | Physical Therapist | 14000 Nicollet Ave Ste 200, Burnsville, MN 55337-5796 | 2017-09-12 |
| 1831538750 | Matthew Marcellus | Physical Therapist | 1305 Fremont Ct, Burnsville, MN 55306-5469 | 2013-06-25 |
| 1104181924 | Alison Mary Kubat | Physical Therapist | 675 East Nicollet Blvd, Oak Ridge East, #135, Burnsville, MN 55337-6741 | 2012-07-09 |
| 1982872537 | Molly Elizabeth Lee | Physical Therapist | 12400 Portland Ave Ste 140, Burnsville, MN 55337-6805 | 2008-02-18 |
| 1477682110 | Phoenix Physical Therapy | Physical Therapist | 3200 Corporate Center Dr Ste 113, Burnsville, MN 55306-5540 | 2007-03-05 |
| 1093720773 | Brenda Garrett-johnson | Physical Therapist | 1609 County Road 42 W, Suite 206, Burnsville, MN 55306-6213 | 2006-07-30 |
| 1568496867 | Sharon Elliott O'connor | Physical Therapist | 305 E Nicollet Blvd, Suite 377, Burnsville, MN 55337-8327 | 2006-07-10 |
| 1578516753 | Cynthia K Devries | Physical Therapist | 14000 Nicollet Ave Ste 110, Burnsville, MN 55337-5734 | 2006-05-18 |
| 1871550376 | Rebecca Ann Rees | Physical Therapist | 12400 Portland Ave, Courage Kenny Rehabilitation Institute, Burnsville, MN 55337-6868 | 2006-04-27 |
| Find all providers in BURNSVILLE | ||||
| City | BURNSVILLE |
| Zip Code | 55337 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.