Maverick Physiotherapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MAVERICK PHYSIOTHERAPY LLC

Practice address

155 Eaton St
Saint Paul, MN 55107-1602

Phone

(612) 642-1847

NPI assigned

Jul 15, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Mason Richlen, DPT, PTNPI 1326610783

Title

Co-Owner

Phone

(715) 271-0303

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mason Richlen, DPT, PT

  • Physical Therapist
  • Saint Paul, MN
  • NPI 1326610783
  Medicare reassignment Care Compare group NPD Authorized official
• Lucas James Voie, PT

  • Physical Therapist
  • Chanhassen, MN
  • NPI 1285360131
  Medicare reassignment Care Compare group NPD
• Eric Stanton Niemyer, DPT

  • Physical Therapist
  • Vadnais Heights, MN
  • NPI 1699341354
  Medicare reassignment NPD

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1073185393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 EATON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071602",
            "telephone_number": "612-642-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 EATON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071602",
            "telephone_number": "612-642-1847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK PHYSIOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "RICHLEN",
        "authorized_official_first_name": "MASON",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "715-271-0303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marena Maupin, RN
• Maureen Gaffey, Psy. D., LLC.
• Maureen Ulbee Psychotherapy PLLC
• Lindsey Lea Maurer
• Brittany Jean Mausolf, LADC, LPCC
• Lisa Maw, CRNA
• Maximal Care LLC
• Maximum Homecare Services LLC
• Maxliving Home Care Services, LLC
• Jason R Maxwell-Wiggins, MD

• Physical Therapist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.