Active NPI
Amanda Nelson
- Physical Therapy Assistant
- Waconia, MN
National Provider Identifier
1093670622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A47
- Practice address
- 500 S Maple St
Waconia, MN 55387-1752 - Phone
- (952) 442-2191
- NPI assigned
- Dec 16, 2025
- 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 | A47 | MN | Primary |
Addresses
Primary practice location
500 S Maple St
Waconia, MN 55387-1752
Mailing address
1392 Shadywood LN
Waconia, MN 55387-1179
Phone (507) 456-7557
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 |
|---|---|---|---|
| A47 | MN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1765843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765843200000",
"number": "1093670622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1392 SHADYWOOD LN",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871179",
"telephone_number": "507-456-7557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S MAPLE ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871752",
"telephone_number": "952-442-2191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-12-16",
"last_updated": "2025-12-16",
"certification_date": "2025-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MN",
"license": "A47",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.