Michelle M Wall, PT/DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10890 Issued in MN

Practice address

3992 133Rd CT W
Rosemount, MN 55068-5338

Phone

(641) 521-4590

NPI assigned

Jul 7, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Michelle Rabedeaux Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wall Works PT LLC

  • Physical Therapy Clinic/Center
  • Richfield, MN
  • NPI 1326638289
  NPD Authorized official
• Therapy Partners, Inc.

  • Multi-Specialty Clinic/Center
  • Saint Paul, MN
  • NPI 1407809494

  Physical Therapist

  NPD (past)
• Waypoint Minnesota PC

  • Chiropractor
  • Maple Grove, MN
  • NPI 1699112805
  NPD (past)

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1366858748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3992 133RD CT W",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550685338",
            "telephone_number": "641-521-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3992 133RD CT W",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550685338",
            "telephone_number": "641-521-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "credential": "PT/DPT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "074480",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "RABEDEAUX",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amelia Jin Yuan Volkert, DDS, MS
• Gunnar Vraa
• Serena Ann Vruno, LICSW
• Walgreen Co
• Kelsey Nicole Wall
• Richard Warmke
• Katelyn Weeres
• Russell C Welch, MD
• Nicole A Welp, RN
• Tim Whiteman, PT

• Physical Therapist in Rosemount, MN
• Providers in Rosemount, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.