Individual provider Active NPI

Molly Marie Stark, DPT

  • Physical Therapist
  • Minneapolis, MN
National Provider Identifier
1497195382
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2985 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 672-7422
Fax
(612) 676-8992
NPI assigned
Jun 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2985 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Other names 1

  • Molly Marie Grames Former name

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

State licenses

LicenseStateTypeSpecialty
2985MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Healtheast Outpatient Services, LLC Physical Therapist CurrentSince May 1, 2023 Accepting new patients
Fairview Express Care CurrentSince May 1, 2023 Accepting new patients
Fairview Express Care CurrentSince May 1, 2023 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

3305 Central Park Village Dr
Ste 130
Eagan, MN 55121
Phone (651) 406-8701

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

3400 W 66th St
Ste 290
Minneapolis, MN 55435
Phone (952) 836-3637

9220 Bass Lake Rd
Ste 260
New Hope, MN 55428
Phone (763) 533-0363

2270 Ford Pkwy
Ste 200
Saint Paul, MN 55116
Phone (651) 696-5000

9680 Tamarack Rd
Ste 130
Woodbury, MN 55125
Phone (612) 273-1172

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497195382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-672-7422",
            "fax_number": "612-676-8922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-672-7422",
            "fax_number": "612-676-8992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MOLLY",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "2985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "GRAMES",
            "middle_name": "MARIE",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.