Active NPI
Kent Worrell Malcomson, PT
- Physical Therapist
- Minneapolis, MN
National Provider Identifier
1225133887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2414
- Practice address
- 2450 Riverside Ave
Suite R102
Minneapolis, MN 55454-1450 - Phone
- (612) 273-9400
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 8, 2007
- 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 | 2414 | MN | Primary |
Addresses
Primary practice location
2450 Riverside Ave
Suite R102
Minneapolis, MN 55454-1450
Mailing address
3320 Yosemite Ave S
St Louis Park, MN 55416-2142
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 |
|---|---|---|---|
| 2414 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225133887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3320 YOSEMITE AVE S",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"address_2": "SUITE R102",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-273-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOMSON",
"first_name": "KENT",
"middle_name": "WORRELL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "2414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, 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.