Active NPI
Samuel Fedo, ATC
- Rehabilitation Practitioner
- Burnsville, MN
National Provider Identifier
1639131279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 1739
- Practice address
- 501 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6732 - Phone
- (952) 460-4900
- Fax
- (952) 460-4901
- NPI assigned
- Apr 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 1739 | MN | Primary |
Addresses
Primary practice location
501 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6732
Mailing address
501 E Nicollet Blvd
Suite 100
Burnsville, MN 55337-6732
Phone (952) 460-4900
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1739 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296604800000",
"number": "1639131279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 E NICOLLET BLVD",
"address_2": "SUITE 100",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553376732",
"telephone_number": "952-460-4900",
"fax_number": "952-460-4901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 E NICOLLET BLVD",
"address_2": "SUITE 100",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553376732",
"telephone_number": "952-460-4900",
"fax_number": "952-460-4901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDO",
"first_name": "SAMUEL",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-06",
"last_updated": "2011-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "MN",
"license": "1739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.