Nautilus LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7889 Issued in MN

Legal business name

NAUTILUS LLC

Doing business as

Replenish Wellbeing

Practice address

4014 Russell Ave N
Minneapolis, MN 55412-1546

Phone

(612) 845-0707

NPI assigned

May 2, 2016

Organization subpart

No

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

Authorized official

Name

Annamaria McConville, PT

Title

Founder

Phone

(612) 845-0707

Specialties & licenses 1

Addresses

Other names 1

• Replenish Wellbeing Doing business as

Locations

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462147200000",
    "number": "1548615131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 RUSSELL AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121546",
            "telephone_number": "612-845-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 RUSSELL AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121546",
            "telephone_number": "612-845-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAUTILUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-02",
        "last_updated": "2016-05-02",
        "status": "A",
        "authorized_official_last_name": "MCCONVILLE",
        "authorized_official_first_name": "ANNAMARIA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "612-845-0707",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "7889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Replenish Wellbeing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; 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.