Active NPI
Melissa Bongard, PT
- Physical Therapist
- Woodbury, MN
National Provider Identifier
1497419873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6991
- Practice address
- 215 Radio Dr Ste 100
Woodbury, MN 55125-5817 - Phone
- (612) 596-6155
- NPI assigned
- Oct 22, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 6991 | MN | Primary |
Addresses
Primary practice location
215 Radio Dr Ste 100
Woodbury, MN 55125-5817
Mailing address
215 Radio Dr Ste 100
Woodbury, MN 55125-5817
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6991 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1497419873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 RADIO DR STE 100",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551255817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 RADIO DR STE 100",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551255817",
"telephone_number": "612-596-6155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONGARD",
"first_name": "MELISSA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "6991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.