Individual provider Active NPI

Dana Nienaber

  • Physical Therapy Assistant
  • Saint Louis Park, MN
National Provider Identifier
1174952386
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
A407 Issued in MN
Practice address
4415 W 36 1/2 St
Saint Louis Park, MN 55416-4854
Phone
(763) 258-3516
Fax
(952) 927-7687
NPI assigned
Nov 7, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X A407 MN Primary

Addresses

Primary practice location

4415 W 36 1/2 St
Saint Louis Park, MN 55416-4854

Mailing address

3436 Aquila Ave S
Saint Louis Park, MN 55426-3834
Phone (763) 258-3516

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A407MNMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1174952386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3436 AQUILA AVE S",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554263834",
            "telephone_number": "763-258-3516",
            "fax_number": "952-927-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 W 36 1/2 ST",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164854",
            "telephone_number": "763-258-3516",
            "fax_number": "952-927-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIENABER",
        "first_name": "DANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.