Active NPI
Mary Kay Rose, P.T.A.
- Physical Therapy Assistant
- Woodbury, MN
National Provider Identifier
1316277148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A1132
- Practice address
- 215 Radio Dr
Woodbury, MN 55125-5815 - Phone
- (612) 596-6100
- Fax
- (612) 339-5954
- NPI assigned
- Dec 29, 2009
- 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 Therapy Assistant | 225200000X | A1132 | MN | Primary |
Addresses
Primary practice location
215 Radio Dr
Woodbury, MN 55125-5815
Mailing address
P.O. Box 209036
Shriners Hospitals for Children R Twin Cities
Dallas, TX 75320-9036
Phone (813) 281-8478
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 |
|---|---|---|---|
| A1132 | MN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608163200000",
"number": "1316277148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 209036",
"address_2": "SHRINERS HOSPITALS FOR CHILDREN R TWIN CITIES",
"city": "DALLAS",
"state": "TX",
"postal_code": "753209036",
"telephone_number": "813-281-8478",
"fax_number": "813-281-8113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 RADIO DR",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551255815",
"telephone_number": "612-596-6100",
"fax_number": "612-339-5954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "MARY",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-29",
"last_updated": "2020-12-17",
"certification_date": "2020-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MN",
"license": "A1132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.