Active NPI
Mariane Lyn Walin, PT, DPT, CIMT
- Physical Therapist
- Big Lake, MN
National Provider Identifier
1497080212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8414
- Practice address
- 18055 198TH Ave NW Unit B161
Big Lake, MN 55309-4926 - Phone
- (612) 200-0619
- Fax
- (612) 844-9108
- NPI assigned
- Oct 13, 2009
- 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 | 8414 | MN | Primary |
Addresses
Primary practice location
18055 198TH Ave NW Unit B161
Big Lake, MN 55309-4926
Mailing address
PO Box 574
Big Lake, MN 55309-0574
Phone (612) 200-0619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00875211 | Other | IL | MEDICARE RAILROAD |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletic and Therapeutic Institute of Naperville, LLC | Physical Therapist | Past | Accepting new patients |
| Total Connection Physical Therapy, LLC | Physical Therapist | Past | Accepting new patients |
| Athletic and Therapeutic Institute of Naperville, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Physical Therapist
- New Brighton, MN
- NPI 1013341353
-
- Physical Therapist
- Willowbrook, IL
- NPI 1144331794
-
- Physical Therapist
- Naperville, IL
- NPI 1902917578
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665532800000",
"number": "1497080212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 574",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553090574",
"telephone_number": "612-200-0619",
"fax_number": "612-844-9108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18055 198TH AVE NW UNIT B161",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553094926",
"telephone_number": "612-200-0619",
"fax_number": "612-844-9108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALIN",
"first_name": "MARIANE",
"middle_name": "LYN",
"credential": "PT, DPT, CIMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-13",
"last_updated": "2022-10-12",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "8414",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00875211",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.