Active NPI
Jason James Stenstrom, PTA
- Physical Therapy Assistant
- Lino Lakes, MN
National Provider Identifier
1255829859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A2129
- Practice address
- 738 Country Lakes Dr
Lino Lakes, MN 55014-5488 - Phone
- (901) 581-1692
- NPI assigned
- Apr 29, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | A2129 | MN | Primary |
Addresses
Primary practice location
738 Country Lakes Dr
Lino Lakes, MN 55014-5488
Mailing address
738 Country Lakes Dr
Lino Lakes, MN 55014-5488
Phone (901) 581-1692
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
| License | State | Type | Specialty |
|---|---|---|---|
| A2129 | MN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524960000000",
"number": "1255829859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "738 COUNTRY LAKES DR",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550145488",
"telephone_number": "901-581-1692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "738 COUNTRY LAKES DR",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550145488",
"telephone_number": "901-581-1692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STENSTROM",
"first_name": "JASON",
"middle_name": "JAMES",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-29",
"last_updated": "2018-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MN",
"license": "A2129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lino Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.