Organization Active NPI

Northfield Physical Therapy LLC

  • Physical Therapist
  • Northfield, MN
National Provider Identifier
1235310913
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NORTHFIELD PHYSICAL THERAPY LLC
Practice address
2500 320TH St W
Northfield, MN 55057-4564
Phone
(507) 581-2452
NPI assigned
Nov 21, 2007
Last updated
Nov 21, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Authorized official

Name
Mr. John Benedict Dudley, PT, CPEDNPI 1598829152
Title
Owner
Phone
(507) 581-2452

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

2500 320TH St W
Northfield, MN 55057-4564

Mailing address

2500 320TH St W
Northfield, MN 55057-4564
Phone (507) 581-2452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080212000698 MN Part B Supplier - Clinic/Group Practice 4284717356 Receives reassigned benefits from 6 practitioners
Practice locations: Northfield, MN

National Provider Directory

National Provider Directory

Locations

516 Water St S
Ste 104
Northfield, MN 55057
Phone (507) 645-8325

618 Division St S
Ste 103
Northfield, MN 55057
Phone (507) 645-8325

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195603200000",
    "number": "1235310913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 320TH ST W",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550574564",
            "telephone_number": "507-581-2452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 320TH ST W",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550574564",
            "telephone_number": "507-581-2452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHFIELD PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2007-11-21",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BENEDICT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-581-2452",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, CPED"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfield, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; 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.