Active NPI
Matthew O'Connor
- Physical Therapist
- Hermantown, MN
National Provider Identifier
1124642079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11839
- Practice address
- 4195 Westberg Rd
Hermantown, MN 55811-2962 - Phone
- (218) 216-9921
- NPI assigned
- Jun 5, 2020
- Sex
- Male
- 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 Therapist | 225100000X | 11839 | MN | Primary |
Addresses
Primary practice location
4195 Westberg Rd
Hermantown, MN 55811-2962
Mailing address
540 Falcon Crest Dr
Spearfish, SD 57783-3252
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 |
|---|---|---|---|
| 11839 | MN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591315200000",
"number": "1124642079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 FALCON CREST DR",
"city": "SPEARFISH",
"state": "SD",
"postal_code": "577833252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4195 WESTBERG RD",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "558112962",
"telephone_number": "218-216-9921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'CONNOR",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-05",
"last_updated": "2020-06-05",
"certification_date": "2020-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.