Active NPI
Danielle Prom, DPT
- Physical Therapist
- Cloquet, MN
National Provider Identifier
1306369319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9184
- Practice address
- 701 Horizon Cir
Cloquet, MN 55720-3051 - Phone
- (218) 879-6956
- NPI assigned
- Jul 21, 2017
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9184 | MN | Primary |
Addresses
Primary practice location
701 Horizon Cir
Cloquet, MN 55720-3051
Mailing address
10653 Wayzata Blvd Ste 200
Minnetonka, MN 55305-1543
Phone (952) 224-1919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, MN
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9184 | MN | MD | Physician Assistant |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500595200000",
"number": "1306369319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10653 WAYZATA BLVD STE 200",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051543",
"telephone_number": "952-224-1919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 HORIZON CIR",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557203051",
"telephone_number": "218-879-6956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROM",
"first_name": "DANIELLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-21",
"last_updated": "2017-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "9184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cloquet, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.