Active NPI
Kathy Sue Trautman, PTA
- Physical Therapy Assistant
- Minneapolis, MN
National Provider Identifier
1255420238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 2450 Riverside Ave
Minneapolis, MN 55454-1450 - Phone
- (612) 672-6000
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- 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 Therapy Assistant | 225200000X | Primary |
Addresses
Primary practice location
2450 Riverside Ave
Minneapolis, MN 55454-1450
Mailing address
9101 Old Cedar Ave S
#204
Bloomington, MN 55425-2341
Other names 1
- Kathy Sue Haberer
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255420238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9101 OLD CEDAR AVE S",
"address_2": "#204",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554252341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-672-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAUTMAN",
"first_name": "KATHY",
"middle_name": "SUE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHY",
"last_name": "HABERER",
"middle_name": "SUE",
"credential": "PTA",
"code": "1",
"type": "Former Name"
}
]
}
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.