Active NPI
Tracy L Keller, PT
- Physical Therapist
- Detroit Lakes, MN
National Provider Identifier
1629015300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7331
- Practice address
- 1245 Washington Ave
Detroit Lakes, MN 56501-3905 - Phone
- (218) 846-2000
- NPI assigned
- Jun 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1141 | ND | |
| Physical Therapist | 225100000X | 7331 | MN | Primary |
Addresses
Primary practice location
1245 Washington Ave
Detroit Lakes, MN 56501-3905
Mailing address
PO Box 2010
Fargo, ND 58122-2484
Phone (701) 234-2000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54087 | Medicaid | ND | |
| DA9011015523 | Other | ND | PREFERRED ONE # |
| HP53308 | Other | ND | HEALTHPARTNERS # |
| 26770 | Other | ND | NDBS # |
| 6406051 | Other | ND | MEDICA # |
| 037H4LU | Other | ND | MNBS # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7331 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Foot Doctor, PLLC | Past | Accepting new patients | |
| Rehabauthority, LLC | Physical Therapist | Past | Accepting new patients |
| B.K. Spine Care, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Podiatrist
- Fargo, ND
- NPI 1255505004
-
- Physical Therapist
- Fargo, ND
- NPI 1306923644
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1629015300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2010",
"city": "FARGO",
"state": "ND",
"postal_code": "581222484",
"telephone_number": "701-234-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013905",
"telephone_number": "218-846-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "TRACY",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-01",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "1141",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7331",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54087",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE #",
"identifier": "DA9011015523",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS #",
"identifier": "HP53308",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "26770",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "6406051",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "037H4LU",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.