| Doctor Name: | MR. KELLY J SOUKUP |
| NPI Number: | 1669419610 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 7269 |
| Business Practice Address: | 1000 W 140th St Suite 202 Burnsville, MN - 553374480 |
| Business Phone Number: | 9528083052 |
| Business Fax Number: | 9528462202 |
| Mailing Address: | 19052 Inman Trl, LAKEVILLE |
| State: | MN |
| Postal Code: | 550444701 |
| Phone Number: | 9524696925 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2006 |
| NPI Last Update Date: | 04/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 7269 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |