Mason Richlen, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12286 Issued in MN

Practice address

155 Eaton St
Saint Paul, MN 55107-1602

Phone

(612) 642-1847

NPI assigned

Jul 14, 2021

Sex

Male

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

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Minnesota Medical School, 2021

Medicare assignment

May accept Medicare assignment

Group practices

Maverick Physiotherapy LLCGroup PAC ID 6800278979, 2 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Maverick Physiotherapy LLC

  • Physical Therapist
  • Saint Paul, MN
  • NPI 1073185393
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1326610783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5526 JENNI LN",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105706",
            "telephone_number": "715-271-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 EATON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071602",
            "telephone_number": "612-642-1847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "729 2nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554022405",
            "country_code": "US",
            "telephone_number": "612-642-1847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHLEN",
        "first_name": "MASON",
        "name_prefix": "Dr.",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Richardson, MA, LP
• Constance Lee Richert, R.N.
• Melanie Richert, FNP-BC
• Amanda Jean Richie
• Joanne Sue Richie, RN
• Joni M Richmond, DDS
• Adrienne Jeanette Richter, PA
• Ann E. Richter, OTR
• Emily Richter
• Sarah Ricker, PA-C

• Physical Therapist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.