Basic Information
| Provider Information | |||||||||
| NPI: | 1316609936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLATEN | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 NORTHWOOD DR APT 202 | ||||||||
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| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551212077 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 RADIO DR | ||||||||
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| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528318742 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2021 | ||||||||
| LastUpdateDate: | 09/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.