Active NPI
Maria Anne Jacenko, PT
- Physical Therapist
- Duluth, MN
National Provider Identifier
1003587411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4536
- Practice address
- 724 Maple Grove Rd
Duluth, MN 55811-4521 - Phone
- (218) 724-4900
- NPI assigned
- Sep 24, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4536 | MN | Primary |
Addresses
Primary practice location
724 Maple Grove Rd
Duluth, MN 55811-4521
Mailing address
500 Cross St
Big Stone City, SD 57216-8237
Phone (605) 541-1140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4536 | MN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642032000000",
"number": "1003587411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CROSS ST",
"city": "BIG STONE CITY",
"state": "SD",
"postal_code": "572168237",
"telephone_number": "605-541-1140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 MAPLE GROVE RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558114521",
"telephone_number": "218-724-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACENKO",
"first_name": "MARIA",
"middle_name": "ANNE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-24",
"last_updated": "2022-01-13",
"certification_date": "2022-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "4536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.