Marci Lynn Pettman, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5204 Issued in MN

Practice address

11800 Xeon Blvd NW
Coon Rapids, MN 55448-2061

Phone

(763) 489-3638

Fax

(763) 647-3885

NPI assigned

Mar 18, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marci Lynn Danielson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1285383216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 MINNEHAHA AVE W STE 300",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551041033",
            "telephone_number": "651-748-4338",
            "fax_number": "651-748-2892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 XEON BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482061",
            "telephone_number": "763-489-3638",
            "fax_number": "763-647-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTMAN",
        "first_name": "MARCI",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-18",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARCI",
            "last_name": "DANIELSON",
            "middle_name": "LYNN",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Scott M Peterson, CRNA
• Shelley Karee Peterson
• Tammy Hartnett Peterson, OD
• Terri Jo Peterson, NP
• Anastajia Pettis
• Kendall Petty, CRNA
• Sean Matthew Pfundstein, PHARMD
• Michael Philbrook, PHARM.D.
• Cheyenne Rose Phillips
• David M Phillips, D.D.S.

• Physical Therapist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.