McKayla Petersen, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2110 Issued in ND

Practice address

701 W 6TH St
Grafton, ND 58237-1379

Phone

(701) 871-8765

Fax

(701) 352-4410

NPI assigned

May 11, 2017

Last updated

Aug 27, 2021By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Life Skills and Transition Center

  • Intellectual Disabilities Intermediate Care Facility
  • Grafton, ND
  • NPI 1558427708
  Medicare reassignment
• Life Skills and Transition Center

  • Community/Behavioral Health Agency
  • Grafton, ND
  • NPI 1023751971
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1114454923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W 6TH ST",
            "city": "GRAFTON",
            "state": "ND",
            "postal_code": "582371379",
            "telephone_number": "701-352-4552",
            "fax_number": "701-365-8134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W 6TH ST",
            "city": "GRAFTON",
            "state": "ND",
            "postal_code": "582371379",
            "telephone_number": "701-871-8765",
            "fax_number": "701-352-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MCKAYLA",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1472555",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory L Paintner, PT
• Alissa Lynn Parsons
• Kari Pastorek, PHARMD
• Mackenzie Paulson
• Dean Allen Pavlicek, MS
• Jordan Marie Peterson, PHARMD
• Gabrielle A Pfingsten, M.S.,CF-SLP
• Mikayla Beth Phelps, PHARMD
• Michaela B Pollock
• Anne Presteng, MS.CCC-SLP

• Physical Therapist in Grafton, ND
• Providers in Grafton, ND by specialty
• Physical Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.