Katelyn Stasney, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A2484 Issued in MN

Practice address

900 Hilligoss Blvd SE
Fosston, MN 56542-1542

Phone

(218) 435-1133

NPI assigned

Jan 27, 2021

Last updated

Aug 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1568053106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-1133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "619 6th St W",
            "address_purpose": "LOCATION",
            "city": "Park Rapids",
            "state": "MN",
            "postal_code": "564701301",
            "country_code": "US",
            "telephone_number": "218-732-3329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STASNEY",
        "first_name": "KATELYN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A2484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Essentiahealth.org",
            "affiliation": "N",
            "address_1": "900 Hilligoss Blvd SE",
            "city": "Fosston",
            "state": "MN",
            "country_code": "US",
            "postal_code": "565421542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• The MRMS Research Foundation
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• Mallory Alice Vig, OTR

• Physical Therapy Assistant in Fosston, MN
• Providers in Fosston, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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.