Maria Walde-Douglas

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4551 Issued in MN

Practice address

6701 Country Club Dr
Golden Valley, MN 55427-4602

Phone

(952) 993-5495

NPI assigned

Dec 21, 2009

Last updated

Dec 21, 2009By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  NPD

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261353600000",
    "number": "1316276454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 210",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728",
            "telephone_number": "952-993-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 COUNTRY CLUB DR",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274602",
            "telephone_number": "952-993-5495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDE-DOUGLAS",
        "first_name": "MARIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert K Vucinovich, M.S.L.P.
• Zoua Vue, LMFT
• Kayla Wacektheis, LMFT
• Trevor Arthur Wagner
• Brooke Taylor Wakefield
• Madalyn Waldmann, OTRL
• Walgreen Co (Walgreens #13841)
• Walgreen Co (Walgreens #00430)
• Wendy Sue Walker, LICSW
• Krystle E Lieberman Wall, DC, RD, LD, CBS LC

• Physical Therapist in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.