Mary T Outpatient

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MARY T OUTPATIENT

Practice address

11800 Xeon Blvd NW
Coon Rapids, MN 55448-2061

Phone

(763) 489-3638

Fax

(763) 647-3885

NPI assigned

Jun 15, 2022

Organization subpart

No

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

Authorized official

Name

Jason Tjosvold

Title

Chief Administrative Officer

Phone

(763) 567-8951

Specialties & licenses 2

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mary T Home Health Inc

  • Home Health Agency
  • Coon Rapids, MN
  • NPI 1497923346

  Member Of

  NPD member

Practitioners 1

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.

• Bethany Digiovanni Trang, DPT

  • Physical Therapist
  • Coon Rapids, MN
  • NPI 1568113199
  NPD (past)

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1396475927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 118TH LN NW STE 1",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554487500",
            "telephone_number": "763-219-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 XEON BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482061",
            "telephone_number": "763-489-3638",
            "fax_number": "763-647-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY T OUTPATIENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "TJOSVOLD",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "763-567-8951"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Emily Marx, LPCC
• Mary T Associates Inc
• Mary T Home Health Inc (Mary T Home Health - Hospice)
• Mary T Home Health Inc
• Mary T Hospice
• Beth Tuttle Maschoff, RDN, LD
• Jael Masi
• Rachael Mason
• Moeen Ahmad Masood, M.B., B.S.
• Fediliay Massaquoi

• Physical Therapist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.