Individual provider Active NPI

Maryann S Johnson, PT

  • Physical Therapist
  • Woodbury, MN
National Provider Identifier
1114015997
Registry record updated Dec 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2886 Issued in MN
Practice address
4040 Radio Dr
Woodbury, MN 55129-3237
Phone
(651) 439-8807
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2886 MN Primary

Addresses

Primary practice location

4040 Radio Dr
Woodbury, MN 55129-3237

Mailing address

3500 American Blvd W Ste 300
Bloomington, MN 55431-4442
Phone (952) 512-5600

Other names 1

  • Maryann J Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100518000915 MN Practitioner - Physical Therapist in Private Practice 7012046758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

4040 Radio Dr
Woodbury, MN 55129-3237
Phone (651) 439-8807

730 SE 9TH St
Minneapolis, MN 55414-2090
Phone (952) 456-7650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2886MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Feb 2, 2026 Accepting new patients
Infinite Health Collaborative, PA Physical Therapist CurrentSince Feb 2, 2026 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

2700 Vikings Cir
Eagan, MN 55121
Phone (952) 456-7600

3500 American Blvd W
Ste 300
Minneapolis, MN 55431
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

2645 Vikings Cir
Saint Paul, MN 55121
Phone (952) 456-7600

4040 Radio Dr
Woodbury, MN 55129
Phone (514) 398-8076

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766534400000",
    "number": "1114015997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 AMERICAN BLVD W STE 300",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314442",
            "telephone_number": "952-512-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551293237",
            "telephone_number": "651-439-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARYANN",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2025-12-24",
        "certification_date": "2025-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "2886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYANN",
            "last_name": "SMITH",
            "middle_name": "J",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.