Active NPI
Mary Kathleen Delacy, PT
- Physical Therapist
- Woodbury, MN
National Provider Identifier
1003883208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6201
- Practice address
- 6025 Lake Rd
Woodbury, MN 55125-1712 - Phone
- (612) 439-4222
- Fax
- (651) 730-1979
- NPI assigned
- Mar 7, 2006
- 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 | 6201 | MN | Primary |
Addresses
Primary practice location
6025 Lake Rd
Woodbury, MN 55125-1712
Mailing address
6025 Lake Rd Ste 200
Woodbury, MN 55125-1710
Phone (612) 439-4222
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 |
|---|---|---|---|
| 6201 | MN | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604620800000",
"number": "1003883208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6025 LAKE RD STE 200",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551251710",
"telephone_number": "612-439-4222",
"fax_number": "651-730-1979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6025 LAKE RD",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551251712",
"telephone_number": "612-439-4222",
"fax_number": "651-730-1979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELACY",
"first_name": "MARY",
"middle_name": "KATHLEEN",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-07",
"last_updated": "2020-11-06",
"certification_date": "2020-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "6201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.