Active NPI
Jennifer Lynn Wiitala, PTA
- Physical Therapy Assistant
- New Brighton, MN
National Provider Identifier
1073914818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A1007
- Practice address
- 825 1St Ave NW
New Brighton, MN 55112-6846 - Phone
- (651) 633-7875
- NPI assigned
- Sep 11, 2014
- 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 Therapy Assistant | 225200000X | A1007 | MN | Primary |
Addresses
Primary practice location
825 1St Ave NW
New Brighton, MN 55112-6846
Mailing address
24053 305TH St
Nora Springs, IA 50458-8774
Phone (641) 425-3404
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 |
|---|---|---|---|
| A1007 | MN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410393600000",
"number": "1073914818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24053 305TH ST",
"city": "NORA SPRINGS",
"state": "IA",
"postal_code": "504588774",
"telephone_number": "641-425-3404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 1ST AVE NW",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551126846",
"telephone_number": "651-633-7875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIITALA",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-11",
"last_updated": "2014-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MN",
"license": "A1007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Brighton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.