Individual provider Active NPI

Meagan O'Connor, DPT

  • Physical Therapy Assistant
  • Shoreview, MN
National Provider Identifier
1346857307
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
12063 Issued in MN
Practice address
490 Highway 96 W
Suite 300
Shoreview, MN 55126-1961
Phone
(651) 451-3016
Fax
(651) 407-7040
NPI assigned
Sep 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 12063 MN Primary

Addresses

Primary practice location

490 Highway 96 W
Suite 300
Shoreview, MN 55126-1961

Mailing address

7308 Colfax Ave
Richfield, MN 55423
Phone (612) 708-3739

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230427002861 MN Practitioner - Physical Therapist in Private Practice 9638534522 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12063MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kids Abilities, Inc CurrentSince Jan 17, 2023 Accepting new patients
Kids Abilities, Inc. CurrentSince Jan 17, 2023 Accepting new patients

Locations

4638 Victor Path
Ste 100
Hugo, MN 55038
Phone (651) 407-3777

14663 Mercantile Dr N
Hugo, MN 55038
Phone (612) 405-3156

490 Highway 96 W
Shoreview, MN 55126
Phone (651) 415-5490

490 Highway 96 W
Ste 300
Shoreview, MN 55126
Phone (651) 451-3016

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1346857307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7308 COLFAX AVE",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "612-708-3739",
            "fax_number": "651-407-7064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 HIGHWAY 96 W",
            "address_2": "SUITE 300",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551261961",
            "telephone_number": "651-451-3016",
            "fax_number": "651-407-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "MEAGAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "12063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.

Verify at the official NPI Registry.