NPIMap

Organization Active NPI

Physical Therapy Consultants, Inc.

Doing business as Ham Lake Physical Therapy

  • Physical Therapy Clinic/Center
  • Ham Lake, MN
National Provider Identifier
1366460719
Registry record updated Feb 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PHYSICAL THERAPY CONSULTANTS, INC.
Doing business as
Ham Lake Physical Therapy
Practice address
16210 Aberdeen St NE
Ham Lake, MN 55304-5410
Phone
(763) 413-0880
Fax
(763) 413-0850
NPI assigned
Jul 17, 2006
Last updated
Feb 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2015

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

Authorized official

Name
Mrs. Amy Lynne Rockstad
Title
Director of Operations
Phone
(763) 269-8052

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

16210 Aberdeen St NE
Ham Lake, MN 55304-5410

Mailing address

139 Main Street
P. O. Box 136
Bethel, MN 55005
Phone (763) 269-8051

Other identifiers 3

IdentifierTypeStateIssuer
04T13NEOtherMNBLUE CROSS
633017700MedicaidMN
6409001OtherMNMEDICA

Other names 1

  • Ham Lake Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080715000426 MN Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 4082691852 Practice locations: Andover, MN; Ham Lake, MN; Isanti, MN; North Branch, MN; Ramsey, MN; Saint Francis, MN; Zimmerman, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366460719. Details of each certification follow.

  • CCN 246578 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 246578

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HAM LAKE PHYSICAL THERAPY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Nov 22, 1996
Last certification
Jul 11, 2013
Ownership / control type
Proprietary
Facility address
16210 Aberdeen St NE Ste B
Ham Lake, MN 55304

National Provider Directory

National Provider Directory

Locations

13831 Round Lake Blvd NW
Andover, MN 55304
Phone (763) 421-0141

1574 154th Ave NW
Andover, MN 55304
Phone (763) 433-8108

139 Main St NW
Bethel, MN 55005
Phone (763) 269-8051

18415 Highway 65 NE
Cedar, MN 55011
Phone (763) 413-0880

16210 Aberdeen St NE
Ste B
Ham Lake, MN 55304
Phone (763) 413-0880

2 Enterprise Ave NE
Ste E4
Isanti, MN 55040
Phone (763) 444-8680

5466 Saint Croix Trl
Ste N
North Branch, MN 55056
Phone (651) 674-7589

23212 Saint Francis Blvd NW
Ste 300
Saint Francis, MN 55070
Phone (763) 753-8804

3220 Bridge St NW
Ste 111
Saint Francis, MN 55070
Phone (612) 240-6601

26025 3rd St E
Ste 100
Zimmerman, MN 55398
Phone (763) 482-5270

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424390400000",
    "number": "1366460719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 MAIN STREET",
            "address_2": "P. O. BOX 136",
            "city": "BETHEL",
            "state": "MN",
            "postal_code": "55005",
            "telephone_number": "763-269-8051",
            "fax_number": "763-269-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16210 ABERDEEN ST NE",
            "city": "HAM LAKE",
            "state": "MN",
            "postal_code": "553045410",
            "telephone_number": "763-413-0880",
            "fax_number": "763-413-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CONSULTANTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-02-20",
        "status": "A",
        "authorized_official_last_name": "ROCKSTAD",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "763-269-8052",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "04T13NE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "633017700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6409001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ham Lake Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ham Lake, MN

Sources for this page

Verify at the official NPI Registry.