Active NPI
Prentice Valvick
- Geriatric Physical Therapist
- Mankato, MN
National Provider Identifier
1043874639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- A1546
- Practice address
- 708 Mound Ave
Mankato, MN 56001-1645 - Phone
- (507) 385-4300
- NPI assigned
- Apr 29, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | A1546 | MN | Primary |
Addresses
Primary practice location
708 Mound Ave
Mankato, MN 56001-1645
Mailing address
708 Mound Ave
Mankato, MN 56001-1645
Phone (507) 385-4300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A1546 | Other | MN | BOARD OF PHYSICAL THERAPY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A1546 | MN | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1043874639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "708 MOUND AVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "560011645",
"telephone_number": "507-385-4300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "708 MOUND AVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "560011645",
"telephone_number": "507-385-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALVICK",
"first_name": "PRENTICE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-29",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "MN",
"license": "A1546",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHYSICAL THERAPY",
"identifier": "A1546",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.