Ethos Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10585 Issued in MN

Legal business name

ETHOS PHYSICAL THERAPY LLC

Practice address

2030 Neal St
Redwing, MN 55066

Phone

(507) 951-8822

NPI assigned

Apr 17, 2018

Organization subpart

No

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

Authorized official

Name

Caitlin Larsen, DPTNPI 1114290129

Title

Owner/Therpaist

Phone

(507) 951-8822

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Caitlin Larsen, DPT

  • Physical Medicine & Rehabilitation Physician
  • Coralville, IA
  • NPI 1114290129

  MN

  Medicare reassignment Authorized official
• Kerri Bernadette Houck, PT

  • Physical Therapist
  • Bloomington, MN
  • NPI 1144517848
  Medicare reassignment

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1407343221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 NEAL ST",
            "city": "REDWING",
            "state": "MN",
            "postal_code": "55066",
            "telephone_number": "507-951-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 NEAL ST",
            "city": "REDWING",
            "state": "MN",
            "postal_code": "55066",
            "telephone_number": "507-951-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHOS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "CAITLIN",
        "authorized_official_title_or_position": "OWNER/THERPAIST",
        "authorized_official_telephone_number": "507-951-8822",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.