Active NPI
Elise Vanett Mackenzie, P.T.
- Physical Therapist
- Maplewood, MN
National Provider Identifier
1124106091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1996
- Practice address
- 1570 Beam Ave
Maplewood, MN 55109-1166 - Phone
- (651) 326-7940
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | 1996 | MN | Primary |
Addresses
Primary practice location
1570 Beam Ave
Maplewood, MN 55109-1166
Mailing address
6721 Madison St NE
Fridley, MN 55432-4450
Phone (651) 864-0712
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 652S6MC | Other | MN | BCBS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1996 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124106091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6721 MADISON ST NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324450",
"telephone_number": "651-864-0712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 BEAM AVE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551091166",
"telephone_number": "651-326-7940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENZIE",
"first_name": "ELISE",
"middle_name": "VANETT",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "1996",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "652S6MC",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.