Sally K Paulus, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A708 Issued in MN

Practice address

9751 Regent Ave N
Brooklyn Park, MN 55443-1402

Phone

(763) 315-5351

Fax

(763) 391-5813

NPI assigned

Jul 2, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Saint Therese of Oxbow Lake, LLC

  • Skilled Nursing Facility
  • Brooklyn Park, MN
  • NPI 1619236767
  NPD (past)

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1104662998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S STE 103",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161599",
            "telephone_number": "763-531-5039",
            "fax_number": "763-531-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9751 REGENT AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431402",
            "telephone_number": "763-315-5351",
            "fax_number": "763-391-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULUS",
        "first_name": "SALLY",
        "middle_name": "K",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bharat Velji Pattni
• Shilpa Paul, MD
• Pauline Svare
• Ronald Paulson
• Teresa Mary Paulson, PT
• Kai Cremisius Pavus, MSW LGSW
• PDG,P.a.
• Peaceful Heart Health Group LLC
• Peaceful Heart Health Group LLC
• Peaceful Living Professionals, LLC

• Physical Therapy Assistant in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.