Active NPI
Michele Fitzgibbons
- Physical Therapy Assistant
- Fergus Falls, MN
National Provider Identifier
1306203328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A166
- Practice address
- 1131 S Mabelle Ave
Fergus Falls, MN 56537-3723 - Phone
- (218) 998-1505
- Fax
- (218) 736-1041
- NPI assigned
- Jan 21, 2016
- Sex
- Female
- 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 | A166 | MN | Primary |
Addresses
Primary practice location
1131 S Mabelle Ave
Fergus Falls, MN 56537-3723
Mailing address
1131 S Mabelle Ave
Fergus Falls, MN 56537-3723
Phone (218) 998-1505
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 |
|---|---|---|---|
| A166 | MN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453334400000",
"number": "1306203328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1131 S MABELLE AVE",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565373723",
"telephone_number": "218-998-1505",
"fax_number": "218-736-1041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1131 S MABELLE AVE",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565373723",
"telephone_number": "218-998-1505",
"fax_number": "218-736-1041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGIBBONS",
"first_name": "MICHELE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-21",
"last_updated": "2016-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MN",
"license": "A166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.