Gracen Taylor Eveslage, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13500 Issued in MN

Practice address

4801 W 81St St Ste 112
Bloomington, MN 55437-1111

Phone

(952) 345-3000

Fax

(952) 345-6789

NPI assigned

Jun 7, 2024

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

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• National Dizzy & Balance Center,LTD.

  • Physical Medicine & Rehabilitation Physician
  • Bloomington, MN
  • NPI 1023021938

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1717718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1588406086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W 81ST ST STE 112",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554371111",
            "telephone_number": "952-345-3000",
            "fax_number": "952-345-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W 81ST ST STE 112",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554371111",
            "telephone_number": "952-345-3000",
            "fax_number": "952-345-6789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "162 Cobblestone Ln",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553374578",
            "country_code": "US",
            "telephone_number": "952-345-3000",
            "fax_number": "952-345-6789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1630 101st Ave NE",
            "address_purpose": "LOCATION",
            "city": "Blaine",
            "state": "MN",
            "postal_code": "554493400",
            "country_code": "US",
            "telephone_number": "952-345-3000",
            "fax_number": "952-345-6789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7650 Currell Blvd Ste 260",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551258209",
            "country_code": "US",
            "telephone_number": "952-345-3000",
            "fax_number": "952-345-6789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVESLAGE",
        "first_name": "GRACEN",
        "middle_name": "TAYLOR",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-07",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "13500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bloomington, MN
• Providers in Bloomington, 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 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.