NPIMap

Organization Active NPI

Pequot Lakes Physical Therapy Services, Inc

  • Physical Therapy Clinic/Center
  • Pequot Lakes, MN
National Provider Identifier
1467589101
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PEQUOT LAKES PHYSICAL THERAPY SERVICES, INC
Practice address
31170 Goverment Dr
Pequot Lakes, MN 56472-1001
Phone
(218) 568-5666
Fax
(218) 568-5466
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Kelly Wulf
Title
Office Manager
Phone
(218) 568-5666

Specialties & licenses 1

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

Addresses

Primary practice location

31170 Goverment Dr
Pequot Lakes, MN 56472-1001

Mailing address

31170 Goverment Dr
PO Box 331
Pequot Lakes, MN 56472-1001
Phone (218) 568-5666

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467589101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31170 GOVERMENT DR",
            "address_2": "PO BOX 331",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564721001",
            "telephone_number": "218-568-5666",
            "fax_number": "218-568-5466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31170 GOVERMENT DR",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564721001",
            "telephone_number": "218-568-5666",
            "fax_number": "218-568-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEQUOT LAKES PHYSICAL THERAPY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WULF",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "218-568-5666",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pequot Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.