Courtney Suppa, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12359 Issued in MN

Practice address

111 17TH Ave E
Alexandria, MN 56308-5273

Phone

(320) 762-1511

Fax

(320) 762-6857

NPI assigned

Sep 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Blue Stone Therapy Inc.

  • Physical Medicine & Rehabilitation Physician
  • Urbandale, IA
  • NPI 1932797297

  MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1154090462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 17TH AVE E",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085273",
            "telephone_number": "320-762-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 17TH AVE E",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085273",
            "telephone_number": "320-762-1511",
            "fax_number": "320-762-6857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPPA",
        "first_name": "COURTNEY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "2603",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Leo Strouth, DPT
• Brianna Summer
• Summit Chiropractic Care PLLC
• Scott A Sundby, MD
• Supervalu Pharmacies Inc
• Beth Marie Swanson, ATC
• Sven Swanson, RPH
• Brielle Joy Swanstrom, MD
• Andrea L Swenson, DNP, APRN, AGCNS-BC
• Crystal Swenson, SLP

• Physical Therapist in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.