Minnesota Medical and Rehabilitative Services, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1544 Issued in MN

Legal business name

MINNESOTA MEDICAL AND REHABILITATIVE SERVICES, LLC

Doing business as

Minnesota Medical and Rehabilitation

Practice address

4201 Excelsior Blvd
St. Louis Park, MN 55416-4728

Phone

(952) 564-3880

Fax

(952) 945-9536

NPI assigned

Nov 11, 2005

Reactivated

May 28, 2022

Last updated

Sep 18, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacob I Mirman, MDNPI 1568404440

Title

Managing Partner

Phone

(952) 933-8900

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• Minnesota Medical and Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob Isaac Mirman, M.D.

  • Internal Medicine Physician
  • St Louis Park, MN
  • NPI 1568404440
  Medicare reassignment Care Compare group NPD Authorized official
• Nina Bacaner, MD

  • Internal Medicine Physician
  • Minneapolis, MN
  • NPI 1578576021
  Medicare reassignment Care Compare group NPD
• Taran John Barrett, DC

  • Chiropractor
  • St Louis Park, MN
  • NPI 1285205351
  Medicare reassignment Care Compare group NPD
• Lawrence Warren Biel, M.D.

  • Surgery Physician
  • Forest Lake, MN
  • NPI 1508818824
  Medicare reassignment Care Compare group NPD
• Ellen N Garbo, MD

  • Psychiatry Physician
  • Saint Paul, MN
  • NPI 1043265689
  Medicare reassignment Care Compare group NPD
• Scott Wagner, PT

  • Physical Therapist
  • St Louis Park, MN
  • NPI 1982648051
  Medicare reassignment Care Compare group NPD
• Olga Karachenets, M.D.

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1164734471
  Medicare reassignment Care Compare group NPD (past)
• Ker Xiong, MSW,LGSW

  • Mental Health Counselor
  • Brooklyn Park, MN
  • NPI 1548809890

  Multi-Specialty

  Medicare reassignment Care Compare group NPD (past)
• Cole Anthony Buchtel, L.I.C.S.W

  • Clinical Social Worker
  • Maplewood, MN
  • NPI 1811281645
  Medicare reassignment NPD
• Sarah A Frid, DC

  • Chiropractor
  • St Louis Park, MN
  • NPI 1538766324
  Medicare reassignment NPD
• Bettejane Kremen Goldman, M.S., R.D., L.D.

  • Registered Dietitian
  • St Louis Park, MN
  • NPI 1528211836
  Medicare reassignment NPD
• Jill Maven Gray, PSYD, LP

  • Clinical Psychologist
  • St Louis Park, MN
  • NPI 1124124045
  Medicare reassignment NPD

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1154302545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-564-3880",
            "fax_number": "952-945-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA MEDICAL AND REHABILITATIVE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "deactivation_date": "2022-03-29",
        "reactivation_date": "2022-05-28",
        "status": "A",
        "authorized_official_last_name": "MIRMAN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "952-933-8900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "2264",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5806",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "1544",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "102980",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "5169",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "6034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154302545",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407858600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Medical and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mincep Epilepsy Care PA (Minnesota Comprehensive Epilepsy Program, P.A.)
• Mind Matters Limited Liability Company
• Caroline Minkus, MD
• Shannon Minnehan, CRNA, PMHNP-BC
• Minnesota Chirohealth of West End LLC (west end chiropractic)
• Minnesota Orthopedics PA
• Minor Medical Squad PLLC
• Nicholas Alexander Minotte
• Deborah Hametz Mintz, OT
• Minute Health LLC

• Physical Therapist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.