Active NPI
Nicole Varichak
- Pediatric Physical Therapist
- Burnsville, MN
National Provider Identifier
1285389148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 12553
- Practice address
- 150 Cobblestone LN
Burnsville, MN 55337-4578 - Phone
- (952) 460-4960
- NPI assigned
- Feb 18, 2022
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 12553 | MN | Primary |
Addresses
Primary practice location
150 Cobblestone LN
Burnsville, MN 55337-4578
Mailing address
10565 Penn Ave S
Bloomington, MN 55431-3443
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 |
|---|---|---|---|
| 12553 | MN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645142400000",
"number": "1285389148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10565 PENN AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554313443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 COBBLESTONE LN",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553374578",
"telephone_number": "952-460-4960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARICHAK",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-18",
"last_updated": "2022-02-18",
"certification_date": "2022-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "MN",
"license": "12553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.