Justin Charles Wilson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

14451 Grand Ave
Burnsville, MN 55306-5708

Phone

(952) 993-8700

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment Care Compare group NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Park Nicollet Clinic

  • Clinic/Center
  • St Louis Park, MN
  • NPI 1275232423
  NPD (past)

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1265006712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8337 BARTON AVE NW",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132749",
            "telephone_number": "763-688-1987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14451 GRAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065708",
            "telephone_number": "952-993-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Park Nicollet Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554162527",
            "country_code": "US",
            "telephone_number": "952-993-3400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4155 County Road 101 N",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MN",
            "postal_code": "554462307",
            "country_code": "US",
            "telephone_number": "952-993-8900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Lake Dr E",
            "address_purpose": "LOCATION",
            "city": "Chanhassen",
            "state": "MN",
            "postal_code": "553179302",
            "country_code": "US",
            "telephone_number": "952-993-4300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15111 Twelve Oaks Center Dr",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553055201",
            "country_code": "US",
            "telephone_number": "952-993-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15301 Grove Cir N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694475",
            "country_code": "US",
            "telephone_number": "952-993-5900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Blaisdell Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554042414",
            "country_code": "US",
            "telephone_number": "952-993-5900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8455 Flying Cloud Dr",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553443974",
            "country_code": "US",
            "telephone_number": "952-993-7400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JUSTIN",
        "middle_name": "CHARLES",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Michael Willier
• Jeffrey Jon Willis, D.O.
• Lydia Marissa Willson
• Amber Wilson
• Carol Kay Wilson
• Nancy Elizabeth Wilson, L.P.
• Theophilus James Wilson
• Aaron Windfeldt
• Elizabeth Ann Winkels, RBT
• Dorothy Eleanor Wintz, MA, LP

• Physical Therapist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.