Active NPI
Lisa Youn Kyung Otto, DPT
- Physical Therapist
- St Louis Park, MN
National Provider Identifier
1396414553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11012
- Practice address
- 6500 Excelsior Blvd
St Louis Park, MN 55426-4702 - Phone
- (952) 993-5486
- NPI assigned
- Sep 10, 2021
- 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 Therapist | 225100000X | 11012 | MN | Primary |
Addresses
Primary practice location
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Mailing address
4321 5TH St NE
Columbia Heights, MN 55421-2826
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1396414553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4321 5TH ST NE",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554212826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 EXCELSIOR BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554264702",
"telephone_number": "952-993-5486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "LISA",
"middle_name": "YOUN KYUNG",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-10",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.