NPIMap

Organization Active NPI

Park Nicollet

  • Physical Therapy Clinic/Center
  • Eden Prairie, MN
National Provider Identifier
1053623785
Registry record updated Jul 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
8510 Issued in MN
Legal business name
PARK NICOLLET
Practice address
8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974
Phone
(952) 993-7470
NPI assigned
Jul 10, 2010
Last updated
Jul 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Abelson, MD
Title
President/Ceo
Phone
(952) 993-5009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 8510 MN Primary

Addresses

Primary practice location

8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974

Mailing address

8455 Flying Cloud Dr
Eden Prairie, MN 55344
Phone (952) 993-7470

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0400452Park Nicollet Clinic - Prairie Center8455 Flying Cloud Dr, Eden Prairie, MN 55344AccreditationDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278720000000",
    "number": "1053623785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8455 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55344",
            "telephone_number": "952-993-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8455 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443974",
            "telephone_number": "952-993-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-10",
        "last_updated": "2010-07-10",
        "status": "A",
        "authorized_official_last_name": "ABELSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "952-993-5009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": "8510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.