NPIMap

Organization Active NPI

Professional Physical Therapy PA

  • Physical Therapist
  • Burnsville, MN
National Provider Identifier
1508902636
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2187 Issued in MN
Legal business name
PROFESSIONAL PHYSICAL THERAPY PA
Practice address
13786 Frontier CT
#102
Burnsville, MN 55337
Phone
(952) 891-2645
Fax
(952) 997-3410
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Michael Fricke, PTNPI 1942215611
Title
Owner
Phone
(952) 891-2645

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 2187 MN Primary
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 2187 MN

Addresses

Primary practice location

13786 Frontier CT
#102
Burnsville, MN 55337

Mailing address

27 Marcin Hill
Burnsville, MN 55337
Phone (952) 891-2645

Other identifiers 4

IdentifierTypeStateIssuer
6407997OtherMNMEDICA
1012293OtherMNPREFERRED ONE
264019500OtherMNUS DEPT OF LABOR
7G667PROtherMNBCBS OF MN

Other names 1

  • Pro Physical Therapy PA Former legal business name

National Provider Directory

National Provider Directory

Locations

13786 Frontier Ct
Ste 102
Burnsville, MN 55337
Phone (952) 891-2645

Practitioners & affiliated clinicians

Practitioners 1

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1508902636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MARCIN HILL",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-891-2645",
            "fax_number": "952-997-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13786 FRONTIER CT",
            "address_2": "#102",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-891-2645",
            "fax_number": "952-997-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHYSICAL THERAPY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "FRICKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-891-2645",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "2187",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MN",
            "license": "2187",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6407997",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1012293",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "264019500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "7G667PR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Physical Therapy PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.