Mark Laraway, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10615 Issued in MN

Practice address

430 5TH St N
Breckenridge, MN 56520-1426

Phone

(218) 641-7725

Fax

(218) 641-6625

NPI assigned

Jul 28, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Total Balance Physical Therapy and Fitness, LLCGroup PAC ID 8820356991, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Total Balance Physical Therapy and Fitness, LLC

  • Physical Therapist
  • Fargo, ND
  • NPI 1588175061
  Medicare reassignment Care Compare group NPD
• Total Balance Dietitian, LLC

  • Registered Dietitian
  • Fargo, ND
  • NPI 1255190534
  NPD (past)

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1548713357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725",
            "fax_number": "218-641-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725",
            "fax_number": "218-641-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARAWAY",
        "first_name": "MARK",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-28",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "3626",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1470616",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Marie Krause Roberts, PT
• Jessica Krauth, APRN,CNP, DNP
• Jessica Lynn Kurth
• Kaylen Kvidt, PT, DPT, ATC
• Sarah Lansing, DPT
• Life Transformations
• Vartan Malkasian, M.D.
• Kallie Marsh
• Jon David McDonald, D.C.
• Amy McIntosh

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.