Provider Demographics
NPI:1750597720
Name:SERES, KYLENE RENEE
Entity type:Individual
Prefix:MRS
First Name:KYLENE
Middle Name:RENEE
Last Name:SERES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KYLENE
Other - Middle Name:RENEE
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 LYNN AVE
Mailing Address - Street 2:APT 25
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4038
Mailing Address - Country:US
Mailing Address - Phone:612-306-7362
Mailing Address - Fax:
Practice Address - Street 1:4801 MINNETONKA BLVD
Practice Address - Street 2:POSITIVE BODY DYNAMICS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4038
Practice Address - Country:US
Practice Address - Phone:952-920-9514
Practice Address - Fax:952-920-9814
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist